Positive FIT Test Results and Abnormal Stool Shapes

Fecal immunochemical test (FIT) positive*; stool occasionally has grooves?

I would like to ask the doctor about my bowel movements over the past six months.
They have often been loose or small, with occasional normal-sized hard stools, but the latter is not very frequent.
I also frequently notice undigested food in my stool.
What concerns me the most is that there is often a groove or flattened shape on the surface of the stool, regardless of whether it is soft or hard.

1.
Can hemorrhoids cause stool to have grooves, or does it necessarily indicate polyps or tumors? I read online that hemorrhoids typically result in softer stools and do not usually cause the stool to become thin or have indentations.
Is it true that indentations usually indicate polyps or tumors?
2.
Since I am still studying abroad, I cannot frequently return to Taiwan and can only see a family doctor here for blood tests or stool tests, then review the reports with my family doctor.
Earlier this month, I underwent a FIT (Fecal Immunochemical Test), and the result was positive, which has made me very worried.
The foreign doctor said they would refer me to a specialist for a colonoscopy.
Although my menstrual period was not completely over on the day of the stool test, there was basically no blood.
Given that I have been experiencing bowel issues for about six months, I used to have a bowel movement once a day, but now I often have two.
With the occasional grooves in my stool, I feel that even if my period ends completely, there is a high probability that the report will still be positive.
Does a positive FIT indicate a high likelihood of polyps or tumors, or could it also be due to gastrointestinal bleeding or blood in the urine?
3.
I plan to return to Taiwan for the Lunar New Year and want to take this opportunity to get checked.
Do you have any recommended tests? I am currently considering a colonoscopy and gastroscopy, and I also want to check if I have anemia (I read online that severe anemia could be associated with colon cancer).
I am considering returning to Taiwan because the process is very slow here.
I have a chocolate cyst, and it took seven months just to get a referral from my family doctor to a specialist in obstetrics and gynecology.
I am really worried about waiting for a colonoscopy here.
If I want to have surgery for the chocolate cyst and undergo gastrointestinal examinations in Taiwan, will there be any conflicts? Which should I do first?
4.
The foreign doctor only informed me about the presence of occult blood in my stool and did not mention anything else.
They asked me to undergo another test called serum folate.
What is this, and is it related to anemia? I read online that stool occult blood tests can also indicate how much blood is present and the concentration of hemoglobin.
Should I ask the foreign doctor about this? I am asking these questions because I feel very anxious, and doctors here often do not provide much information.
Even when I requested the stool occult blood result, it only indicated positive/abnormal without specifying hemoglobin concentration, etc.
The inefficiency here is quite frustrating.

Thank you, doctor, for taking the time to read this lengthy message, and I appreciate your professional answers to my questions.

Xue, 20~29 year old female. Ask Date: 2019/12/16

Dr. Chen Shidian reply Gastroenterology and Hepatology

Patients who test positive for FIT should undergo a colonoscopy to confirm the cause, just to be safe.
It is also recommended to provide a copy of the test results to the hospital for the purpose of applying for advanced examinations such as a colonoscopy.
As for what specific tests to conduct, it is advisable to respect and follow the recommendations of the specialist physician.

Reply Date: 2019/12/16

More Info

Your concerns regarding your bowel movements and the positive FIT (Fecal Immunochemical Test) result are valid and warrant careful consideration. Let's address your questions one by one.

1. Can hemorrhoids cause stool to have grooves?
Hemorrhoids typically do not cause stool to have grooves or be flattened. They can lead to softer stools due to discomfort during bowel movements, but the characteristic of having a groove or being thin often indicates a potential obstruction in the colon, such as polyps or tumors. When stool appears thin or has a groove, it is essential to investigate further, as these changes can be associated with more serious conditions.

2. What does a positive FIT result mean?
A positive FIT result indicates the presence of blood in the stool, which can arise from various sources, including benign conditions like hemorrhoids or fissures, but it can also suggest more serious issues such as polyps, tumors, or gastrointestinal bleeding. It is crucial to follow up with a colonoscopy, as this procedure allows for direct visualization of the colon and the opportunity to biopsy any suspicious lesions. While a positive FIT does raise concerns about the possibility of polyps or tumors, it does not definitively indicate cancer. Other factors, such as gastrointestinal bleeding from ulcers or other sources, can also contribute to a positive result.

3. Recommended examinations upon returning to Taiwan:
Given your symptoms and the positive FIT result, it would be prudent to undergo both a colonoscopy and an upper gastrointestinal endoscopy (gastroscopy) to evaluate your digestive tract thoroughly. These procedures can help identify any abnormalities in the colon and stomach, including the presence of polyps, tumors, or signs of bleeding. Regarding your concern about anemia, it is wise to have a complete blood count (CBC) performed to check for anemia, which can be associated with gastrointestinal bleeding. If you have a chocolate cyst, it is generally safe to have both procedures done; however, it is advisable to discuss the timing and order of these procedures with your healthcare provider to ensure that they do not interfere with each other.

4. What is serum folate, and how does it relate to anemia?
Serum folate is a blood test that measures the level of folate (vitamin B9) in your blood. Folate is crucial for the production of red blood cells, and low levels can lead to a type of anemia known as megaloblastic anemia. This condition is characterized by the production of large, immature red blood cells that are ineffective in carrying oxygen. If your healthcare provider has recommended this test, it may be to rule out folate deficiency as a cause of any anemia you may have.

In summary, your symptoms and the positive FIT result necessitate further investigation through a colonoscopy and possibly an upper endoscopy. It is essential to address these issues promptly, especially considering your concerns about potential gastrointestinal bleeding and the presence of polyps or tumors. When you return to Taiwan, make sure to discuss your symptoms and test results with a healthcare provider who can guide you through the necessary examinations and any subsequent treatment options. Your health is paramount, and taking these steps will help ensure that any underlying issues are identified and managed appropriately.

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