Bowel Issues After Colonoscopy: What You Need to Know

Q: Bowel Issues After Colonoscopy: What You Need to Know

Hello： A 43-year-old female has a 2 cm well-differentiated polyp that needs to be completely excised! Close monitoring is required (every three months, six months, to one year, based on the physician's clinical assessment)! Generally, after the removal of a tubular adenoma, it is

Bowel-related issues?

I am 43 years old.
Last October, I underwent my first colonoscopy, which revealed two 2 cm linear polyps.
The biopsy results showed one was benign, while the other was a well-differentiated adenocarcinoma (considered carcinoma in situ).
A month later, I had another colonoscopy, which found two 0.3 cm hyperplastic polyps and one 0.5 cm linear polyp, all of which were benign.
My doctor advised me to follow up in a year.

Previously, I had constipation and relied on traditional Chinese medicine or senna leaves to help with bowel movements, which worked well.
However, since the colonoscopy, I have been hesitant to use any medications to aid my bowel movements.
Interestingly, I have not experienced constipation since then; my bowel movements vary from frequent to infrequent, but none have been well-formed.
They are mostly very soft or watery.
I love eating vegetables and have been consuming plenty of fruits and drinking a lot of water.
Recently, my stools have been watery, and I haven't even had soft stools.

Since the colonoscopy, I have been taking probiotics (Lactobacillus).
However, I notice that my flatulence is quite foul, and my bowel movements also have a strong odor.
I consulted my doctor, who mentioned it could be irritable bowel syndrome.
I am concerned about the well-differentiated linear polyp found during last year's colonoscopy.
Is it possible that my current bowel issues are related to the presence of that linear polyp or that new ones have developed? I am genuinely worried.
Thank you for your assistance.

Wenwen, 40~49 year old female. Ask Date: 2020/04/27

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello: A 43-year-old female has a 2 cm well-differentiated polyp that needs to be completely excised! Close monitoring is required (every three months, six months, to one year, based on the physician's clinical assessment)! Generally, after the removal of a tubular adenoma, it is recommended to have a follow-up colonoscopy every 3-5 years.
Constipation can have many causes, including diet, emotions, endocrine factors, or issues with the intestines themselves.
It is advised to continue outpatient follow-up and treatment examinations! Wishing you peace and health! Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2020/04/27

More Info

Understanding bowel issues after a colonoscopy can be a complex topic, especially for individuals who have had previous findings such as polyps or abnormal growths. Your situation, involving the discovery of two linear polyps—one benign and one classified as high-grade dysplasia (considered a form of carcinoma in situ)—is particularly noteworthy. This history necessitates careful monitoring and understanding of your current bowel habits.

After a colonoscopy, it is not uncommon for patients to experience changes in bowel habits. These changes can manifest as alterations in stool consistency, frequency, and odor. In your case, you mentioned that since the procedure, you have not experienced constipation, which is a positive development given your previous reliance on herbal remedies and senna leaves for bowel movements. However, the shift to softer or more liquid stools can be concerning, especially when accompanied by foul-smelling gas.

The fact that you are consuming a diet rich in vegetables, fruits, and water is beneficial for digestive health. High-fiber diets typically promote regular bowel movements and can help maintain stool consistency. However, if your stools remain consistently loose or watery, it may indicate an underlying issue that needs to be addressed.

One possibility is that your gastrointestinal tract may be reacting to the colonoscopy itself. Some patients report changes in bowel habits following the procedure, which could be due to several factors, including the preparation for the colonoscopy, the procedure itself, or even anxiety about the findings. Additionally, the introduction of probiotics like Lactobacillus (as you mentioned taking "洛克飛") can sometimes lead to changes in bowel flora, which might temporarily affect stool consistency.

Regarding your concern about the potential presence of polyps or the development of new growths, it is essential to understand that while the colonoscopy is a valuable diagnostic tool, it does not guarantee that new polyps will not develop in the future. The fact that you have had previous polyps, especially one with high-grade dysplasia, places you at a higher risk for colorectal cancer. However, it is also important to note that the majority of polyps are benign, and regular surveillance is crucial.

Your doctor’s diagnosis of irritable bowel syndrome (IBS) could explain the changes in your bowel habits. IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and changes in bowel habits (diarrhea or constipation). Stress, dietary changes, and gut flora imbalances can all contribute to IBS symptoms.
To address your concerns, I recommend the following steps:
1. Follow-Up with Your Gastroenterologist: Given your history and current symptoms, it is crucial to maintain regular follow-ups with your gastroenterologist. They may recommend a repeat colonoscopy sooner than the one-year mark if your symptoms persist or worsen.

2. Dietary Adjustments: While a high-fiber diet is generally beneficial, consider keeping a food diary to identify any potential triggers that may exacerbate your symptoms. Some individuals with IBS find that certain foods (like dairy, gluten, or high-FODMAP foods) can worsen their condition.

3. Probiotic Use: Continue taking probiotics, but monitor how your body responds. Sometimes, it may take time for your gut to adjust, or you may need to try different strains.

4. Stress Management: Since stress can significantly impact IBS symptoms, consider incorporating stress-reduction techniques such as mindfulness, yoga, or regular exercise into your routine.

5. Symptom Monitoring: Keep track of your bowel habits, including frequency, consistency, and any associated symptoms like pain or bloating. This information can be invaluable for your healthcare provider in determining the best course of action.

In summary, while your history of polyps raises valid concerns, the changes in your bowel habits could be attributed to various factors, including dietary changes, the effects of the colonoscopy, or IBS. Regular monitoring and open communication with your healthcare provider are essential to ensure your gastrointestinal health remains a priority.

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