Abnormal Stool Shapes: Causes and Concerns

Bowel-related issues include stool that is either unformed or flat in shape?

Hello, Dr.
Hsu: Two years ago, I experienced rectal bleeding, so I underwent a colonoscopy.
The doctor diagnosed me with internal hemorrhoids.
Recently, I also had a fecal occult blood test, and the doctor said the results did not meet the threshold for concern, which I don't quite understand.
Yesterday, when I went to the bathroom, my stool was very flat in shape.
Could you please explain why this is happening? Thank you!

Awei, 20~29 year old female. Ask Date: 2020/03/11

Dr. Xu Kaixi reply Surgery

If you had a colonoscopy two years ago and no abnormalities were found except for internal hemorrhoids, there is no need to worry about colorectal issues.
There are many factors that can affect the shape of stool, including the intake of water and dietary fiber.

Reply Date: 2020/03/11

More Info

Abnormal stool shapes can be a cause for concern, especially when accompanied by symptoms such as bleeding or changes in bowel habits. In your case, the observation of flat or thin stools can indicate a few potential issues, particularly given your history of hemorrhoids and previous gastrointestinal evaluations.

Firstly, the shape of your stool can be influenced by several factors, including diet, hydration, and the health of your gastrointestinal tract. Flat stools can sometimes be a sign of a narrowing in the colon, which could be due to various reasons, including inflammation, scarring, or even a mass. Given your history of internal hemorrhoids, it is possible that the changes in stool shape are related to the pressure and changes in the rectal area caused by these hemorrhoids. Hemorrhoids can lead to straining during bowel movements, which might affect stool consistency and shape.

However, it is essential to consider other potential causes for the change in stool shape. For instance, conditions such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or even colorectal cancer can lead to changes in stool appearance. While your recent fecal occult blood test (FOBT) was negative, which is reassuring, it does not entirely rule out the possibility of other underlying conditions.

Here are some important points to consider regarding abnormal stool shapes:
1. Dietary Factors: A diet low in fiber can lead to harder stools that may be more difficult to pass, potentially causing straining and changes in stool shape. Increasing your fiber intake through fruits, vegetables, and whole grains can help improve stool consistency.

2. Hydration: Adequate hydration is crucial for maintaining healthy bowel movements. Dehydration can lead to harder stools, which may also affect their shape.

3. Gastrointestinal Health: Conditions affecting the gastrointestinal tract, such as strictures or tumors, can lead to changes in stool shape. If the stool is consistently flat or thin, it may warrant further investigation.

4. Monitoring Symptoms: Keep track of any additional symptoms you may experience, such as abdominal pain, changes in bowel habits, or any new symptoms. This information can be valuable for your healthcare provider.

5. Follow-Up Care: Given your history and current symptoms, it would be prudent to follow up with your healthcare provider. They may recommend further diagnostic tests, such as imaging studies or a repeat colonoscopy, to evaluate the condition of your colon and rule out any serious issues.

In summary, while flat stools can be related to benign conditions such as hemorrhoids, they can also indicate more serious gastrointestinal issues. It is essential to maintain open communication with your healthcare provider, especially if you notice persistent changes in your bowel habits or experience any concerning symptoms. Regular check-ups and monitoring can help ensure that any potential issues are addressed promptly.

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