Abdominal Pain Before Bowel Movements: Causes and Concerns

Abdominal pain before bowel movement?

Hello, doctor.
I have been experiencing irregular bowel movements for a long time, and it has worsened since I started losing weight this past year.
I usually drink at least 2000 cc of water daily, but I only have a bowel movement every three days, sometimes every two days, and occasionally every three to four days.
Additionally, I have hemorrhoids that occasionally flare up with swelling and pain, although most of the time I don't feel anything.
The shape and consistency of my stools have also become irregular since I started losing weight; sometimes they are pellet-like, and other times they are elongated, with the latter being about 3 centimeters in diameter.
After not having a bowel movement for three days, today I had a larger volume and went about 3 to 4 times, with the last few being somewhat loose, not completely watery, but the stools were not formed together.

In the past month, I have experienced abdominal pain near my navel before having a bowel movement about 3 to 4 times; sometimes the pain is severe, while other times it is tolerable.
The pain improves after I have a bowel movement, and it doesn't happen every time—about once a week.
In late June, after a bowel movement, I noticed a lot of blood above the toilet bowl when I passed gas.
At that moment, there was not much pain, just a little discomfort when wiping.
The blood was bright red, similar to menstrual bleeding.
I am not sure if there was blood in my stool, but the bleeding stopped afterward, although I had a sensation of needing to have a bowel movement above my anus, which resolved after a few days.

I am 28 years old, and I had a tumor marker test on May 26 of last year, with a CEA level of 0.66.
I would like to know if there is a possibility of colorectal cancer and whether I need to undergo a colonoscopy.
I am quite worried.
Thank you for your help, doctor.

S, 20~29 year old female. Ask Date: 2021/08/04

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is just some irritable bowel syndrome; first, adjust the diet to include more fruits and vegetables and increase physical activity.
If necessary, a stool occult blood test can be performed.

Reply Date: 2021/08/04

More Info

Understanding abdominal pain before bowel movements can be quite complex, especially when there are underlying conditions such as hemorrhoids, irregular bowel habits, and changes in stool consistency. Your symptoms, including the abdominal pain near the belly button before bowel movements, the irregularity of your bowel habits, and the history of rectal bleeding, warrant a thorough evaluation.

Firstly, the abdominal pain you experience before bowel movements could be attributed to several factors. One common cause is increased intestinal motility, which can occur as the body prepares for a bowel movement. This can lead to cramping or discomfort in the abdominal area. In your case, the pain seems to alleviate after you have a bowel movement, which is consistent with this explanation.
However, given your history of irregular bowel movements and the presence of hemorrhoids, it is also important to consider other potential causes. Hemorrhoids can cause pain and discomfort, especially if they become inflamed or thrombosed. The fact that you have experienced bright red blood during bowel movements is concerning and should not be overlooked. While it may be related to hemorrhoids, it is essential to rule out other serious conditions, including colorectal cancer, especially since you have mentioned a family history of bowel issues and your age.

Your irregular bowel habits, characterized by infrequent bowel movements (every 2-4 days) and changes in stool consistency, could indicate a condition known as constipation. Constipation can lead to increased straining during bowel movements, which may exacerbate hemorrhoids and contribute to abdominal pain. Additionally, dietary changes associated with weight loss can also impact bowel habits, potentially leading to constipation or altered stool consistency.

The presence of blood in your stool, even if it was only observed once, is a red flag. While it may be due to hemorrhoids, it is crucial to have this evaluated further. The CEA (carcinoembryonic antigen) test you mentioned is a tumor marker that can be elevated in certain cancers, including colorectal cancer, but it is not specific enough to rule out the disease entirely. A normal CEA level does not completely eliminate the possibility of colorectal cancer, especially in the presence of concerning symptoms.

Given your symptoms and concerns, it is highly advisable to undergo a colonoscopy. This procedure allows for direct visualization of the colon and rectum, enabling the physician to identify any abnormalities, such as polyps, inflammation, or tumors. It is generally recommended for individuals with a change in bowel habits, rectal bleeding, or abdominal pain, particularly if these symptoms persist or worsen.

In summary, while your abdominal pain before bowel movements may be related to increased intestinal motility or hemorrhoids, the presence of blood and your irregular bowel habits necessitate further investigation. A colonoscopy is a prudent step to ensure that any potential issues, including colorectal cancer, are identified and addressed promptly. Additionally, discussing your dietary habits and any lifestyle changes with your healthcare provider may help in managing your bowel health more effectively. Remember, early detection and intervention are key in addressing any gastrointestinal concerns.

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