Persistent Bowel Issues: When to Consider a Colonoscopy - Gastroenterology and Hepatology

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Feeling the urge to have a bowel movement again shortly after just having one?


About one to two months ago, I started experiencing frequent bowel sounds, especially after meals or when lying down.
Initially, I didn't think much of it, but after taking antibiotics for six days following a wisdom tooth extraction, I began to have diarrhea.
Even a week after stopping the medication, the diarrhea persisted.
I subsequently consulted both a colorectal specialist and a gastroenterologist, and both stool occult blood tests and blood tests came back normal.
During this time, the doctor prescribed Loperamide and Simethicone.
After a month, the diarrhea has lessened, but I still experience a sensation of incomplete evacuation after bowel movements.
When I sit down, I only pass a small amount, and I feel like I can't clean myself properly afterward.
This has led to increased frequency and itching around the anal area, with the urge to defecate lingering for several hours after using the restroom.
The bowel sounds remain frequent, and my stools are looser with visible fiber.
However, I have not experienced any abdominal pain during this past month.
I would like to ask the doctor if you would recommend a colonoscopy.
Thank you.

Zhuang Xiaojie, 20~29 year old female. Ask Date: 2021/02/14

Dr. Chen Shidian reply Gastroenterology and Hepatology


In typical irritable bowel syndrome, a colonoscopy is generally not necessary.
However, dietary adjustments to reduce oil and dairy intake are recommended, along with medication to manage symptoms.

Reply Date: 2021/02/14

More Info


When dealing with persistent bowel issues, particularly those involving symptoms such as frequent bowel movements, a sensation of incomplete evacuation, and changes in stool consistency, it is essential to approach the situation with a comprehensive understanding of gastrointestinal health. Your symptoms, including bowel sounds, a feeling of incomplete evacuation, and anal discomfort, can be indicative of several underlying conditions, including functional gastrointestinal disorders like irritable bowel syndrome (IBS) or other more serious conditions that may require further investigation.

Given that you have already undergone stool tests and blood tests that returned normal results, this is a positive sign, as it suggests that there are no immediate concerns such as infections or significant inflammatory processes. However, the persistence of your symptoms, especially the sensation of incomplete evacuation and anal discomfort, warrants further evaluation.
In your case, a colonoscopy could be a valuable diagnostic tool. This procedure allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities such as polyps, inflammation, or other structural issues that might not be detectable through non-invasive tests. While your current symptoms may not suggest a severe condition, the fact that you are experiencing ongoing discomfort and changes in bowel habits makes it prudent to consider a colonoscopy, especially if these symptoms persist or worsen.

Additionally, it is important to consider the potential role of diet and lifestyle in your symptoms. For instance, a diet low in fiber or high in processed foods can contribute to bowel irregularities. Increasing dietary fiber gradually, staying hydrated, and incorporating regular physical activity can help improve bowel function. Moreover, stress and anxiety can exacerbate gastrointestinal symptoms, so exploring stress management techniques may also be beneficial.

If you are experiencing anal itching and discomfort, it could be related to irritation from frequent wiping or residual stool. Maintaining proper hygiene, using gentle, non-irritating wipes, and possibly consulting a dermatologist or a gastroenterologist for topical treatments may help alleviate these symptoms.

In summary, while your initial tests are reassuring, the persistence of your symptoms suggests that further evaluation is warranted. A colonoscopy can provide valuable insights into your gastrointestinal health and help rule out any serious conditions. It is also essential to consider dietary modifications and stress management techniques as part of a holistic approach to managing your symptoms. Always consult with your healthcare provider to discuss your symptoms and determine the best course of action tailored to your specific situation.

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