Abnormal Stool Patterns: When to Seek Medical Advice - Gastroenterology and Hepatology

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Bowel issues?


Hello, doctor.
Around April and May, my stools have been about the thickness of my thumb or index finger.
I'm not sure about before that because they were unformed, so I didn't pay much attention as long as they were in a log shape.
Recently, my bowel movements have been as described above.
Since May 18, my stools have consistently been the thickness of my thumb or index finger, sometimes flat.
These situations occur simultaneously; sometimes I have a combination of thumb and index finger thickness, or index finger thickness and flat stools, or possibly just one type, but they are mostly unformed.
However, there have been a few instances of normal thickness, but most of the time, they are about the thickness of my thumb.

Lately, I have been having bowel movements twice a day.
I often wake up in the morning feeling inexplicably anxious, which leads to abdominal pain and then a bowel movement.
The first movement is usually formed, followed by unformed stools.
The second movement is unformed.
Last Friday, May 14, my second bowel movement was mushy, but there was some red around it; I'm not sure if it was blood, as it disappeared when stirred.
This was the only time I noticed something that looked like blood; on other days, I didn't see anything.
There was one instance where I felt constipated and had to strain on the toilet; the first part was the thickness of my index finger, and the latter part was very thin, like a pencil or even thinner.
However, the next day, it returned to what seemed like normal thickness, and then it mixed back into the situations I described earlier.
On Sunday, May 16, after two bowel movements, my stomach felt very uncomfortable, but it got better later.
There were two instances of flat stools; one looked thin but was a bit thicker on the side when turned over.
Another instance was this Monday when I had a stool that was thick, probably the thickness of my thumb or slightly more, but it didn't look round; it seemed more rectangular.
There was also a stool that was about the thickness of my index or thumb.
Today, May 18, I only had one bowel movement, which was a mix of index finger thickness and flat stools, followed by another stool that was index finger thickness.
After finishing, I felt the urge to go again but couldn't, and occasionally I feel a slight stabbing pain in my abdomen, but it's not very painful.
Sometimes I feel a little dull pain or occasional bloating, but I'm not sure if it's due to my emotions.
I might be feeling anxious because I've read some alarming things online, which makes me nervous.
I do eat, but not as much as before; I have three meals a day but not a lot.
Since I have been having daily bowel movements, my weight has dropped from 51-52 kg to just over 50 kg.
Currently, I don't have any significant discomfort or pain.
I tend to be an anxious and nervous person, and I've read some scary things online, so I wanted to ask for your advice first.

YO, 20~29 year old female. Ask Date: 2021/05/18

Dr. Chen Shidian reply Gastroenterology and Hepatology


It is likely an abnormality in colonic motility, rather than a significant issue.
It is advisable to increase the intake of fruits and vegetables and stay hydrated, take walks after meals, maintain an exercise routine, and monitor bowel movements.

Reply Date: 2021/05/18

More Info


Understanding abnormal stool patterns is crucial for recognizing potential health issues, and it’s important to know when to seek medical advice. Based on your description, it seems you are experiencing a variety of stool shapes and consistencies, which can be concerning. Let’s break down the situation and provide some insights.

Firstly, the characteristics of your stool—ranging from thin, pencil-like shapes to more normal forms—can indicate different underlying issues. According to the Bristol Stool Chart, which categorizes stool types, normal stool should ideally be well-formed and easy to pass. Types 1 and 2 indicate constipation, while types 3 and 4 are considered normal. Your mention of stools that are thin or flat could potentially suggest a narrowing of the stool, which can sometimes be associated with conditions affecting the colon, such as inflammation or even more serious conditions like colorectal cancer. However, it’s essential to remember that variations in stool shape can also be due to dietary changes, stress, or gastrointestinal motility issues.

The presence of red coloration in your stool, especially if it resembles blood, is particularly concerning. Even if it appears to dissipate upon mixing, any indication of blood in the stool warrants immediate medical evaluation. Blood can originate from various sources, including hemorrhoids, anal fissures, or more serious gastrointestinal issues.
Your symptoms of abdominal discomfort and changes in bowel habits, coupled with feelings of anxiety, suggest that both physical and psychological factors may be at play. Stress and anxiety can significantly impact gastrointestinal function, leading to symptoms such as abdominal pain, changes in bowel habits, and even the sensation of incomplete evacuation after a bowel movement. This is often referred to as irritable bowel syndrome (IBS), a common condition that can be exacerbated by stress.

Given your situation, here are some recommendations:
1. Keep a Stool Diary: Documenting the characteristics of your stool, along with any accompanying symptoms, can provide valuable information for your healthcare provider. Note the frequency, shape, size, and any changes in color.

2. Dietary Considerations: Evaluate your diet to ensure you are consuming enough fiber, which can help regulate bowel movements. Foods rich in fiber include fruits, vegetables, whole grains, and legumes. Staying hydrated is also crucial.

3. Monitor Symptoms: Pay attention to any additional symptoms such as weight loss, persistent abdominal pain, or changes in appetite. These can be important indicators of underlying health issues.

4. Seek Medical Advice: Given the complexity of your symptoms, particularly the presence of potential blood in your stool and the significant changes in bowel habits, it is advisable to consult a healthcare professional. They may recommend tests such as a colonoscopy or imaging studies to rule out any serious conditions.

5. Manage Anxiety: Since you mentioned feelings of anxiety, consider discussing these with a mental health professional. Techniques such as cognitive-behavioral therapy (CBT), mindfulness, and relaxation exercises can be beneficial in managing anxiety and its physical manifestations.

In summary, while some variations in stool can be benign and related to diet or stress, the combination of your symptoms—especially the potential blood in your stool—should not be ignored. It is essential to consult with a healthcare provider who can perform a thorough evaluation and guide you on the appropriate next steps. Taking proactive measures regarding both your physical and mental health is crucial for your overall well-being.

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