Digestive Issues: When to Seek Further Testing - Gastroenterology and Hepatology

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Bowel issues


Hello Doctor: Since childhood, I have had gastrointestinal issues, frequently experiencing diarrhea and bloating.
Two years ago, I underwent a fecal occult blood test, which was negative, and I was diagnosed with internal hemorrhoids.
In the second half of last year, I experienced bleeding again, and the physician at the same clinic diagnosed it as a recurrence of internal hemorrhoids without performing a digital rectal examination.
After taking medication, I did not experience any further bleeding.
However, in the past six months, possibly due to emotional stress, I have been experiencing significant bloating, and alternating episodes of diarrhea and constipation.
Recently, I have noticed that the diameter of my stool has decreased to 2-2.5 cm, which is slightly thinner than before, with lengths varying from 5 to 15 cm.
The physician previously believed that my issues were purely functional and did not recommend further colonoscopy.
However, the recent changes in my stool have raised my concerns, so I would like to ask if further examination is necessary.
Thank you!

C, 20~29 year old female. Ask Date: 2021/03/13

Dr. Yang Zhichao reply Gastroenterology and Hepatology


Hello Ms.
C, based on your description, irritable bowel syndrome (IBS) is a more likely diagnosis.
However, if you continue to experience rectal bleeding, I recommend scheduling a colonoscopy to rule out some rare inflammatory bowel diseases or tumors.
Thank you for your inquiry.

Reply Date: 2021/03/13

More Info


When it comes to digestive issues, especially those involving changes in bowel habits, it is crucial to understand when further testing is warranted. Based on your description, you have a history of gastrointestinal discomfort, including diarrhea, bloating, and alternating constipation, along with episodes of rectal bleeding that were attributed to internal hemorrhoids. You also mentioned a recent change in the caliber of your stool, which has raised your concerns.

Firstly, it is important to acknowledge that changes in bowel habits can be indicative of various underlying conditions. While functional gastrointestinal disorders, such as irritable bowel syndrome (IBS), are common and can cause symptoms like bloating and alternating bowel habits, any significant changes in stool characteristics, especially if accompanied by rectal bleeding, warrant a careful evaluation.

In your case, the fact that you have experienced a change in the diameter of your stool, particularly if it has become narrower than usual, should not be overlooked. While stool caliber can vary for many benign reasons, a persistent change, especially in the context of previous gastrointestinal symptoms, may raise concerns for potential structural issues, such as polyps or other lesions in the colon.

Given your history of rectal bleeding and the recent changes in your stool, it would be prudent to consider further testing, such as a colonoscopy. A colonoscopy allows for direct visualization of the colon and rectum and can help identify any abnormalities, including polyps, inflammation, or other potential causes of your symptoms. It is particularly important to rule out any serious conditions, especially if there is a family history of colorectal cancer or if you are over the age of 50, as screening recommendations suggest starting regular screenings at this age.

Additionally, while your previous fecal occult blood test was negative, it is important to remember that this test is not definitive. False negatives can occur, and the presence of blood may not always be detected. Therefore, if you are experiencing ongoing symptoms, a repeat evaluation may be necessary.

Moreover, it is essential to communicate openly with your healthcare provider about your concerns. If you feel that your symptoms are not being adequately addressed, seeking a second opinion or requesting a referral to a gastroenterologist may provide you with more comprehensive care. A gastroenterologist specializes in digestive disorders and can offer further insights into your symptoms and the need for additional testing.

In summary, based on your symptoms and the changes you have described, it would be advisable to pursue further evaluation, including a colonoscopy, to ensure that any potential issues are identified and addressed. Early detection and intervention are key in managing gastrointestinal health, and it is always better to err on the side of caution when it comes to changes in bowel habits and rectal bleeding. Your health and peace of mind are paramount, so do not hesitate to advocate for yourself in seeking the necessary tests and evaluations.

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