Flat Stool: Causes and When to Seek Medical Advice

Flat-shaped stools?

Hello, several years ago I had a colonoscopy that revealed a 0.8 cm colorectal adenoma, which was removed.
The doctor advised follow-up in one year to check for a propensity to develop polyps.
During the follow-up, no new polyps were found.
Subsequently, during a follow-up two years later, a 0.2 cm polyp was detected, and I was told to return for another follow-up in three years.
The reason for my initial colonoscopy was recurrent constipation and diarrhea, but the doctor indicated that this was unrelated to the adenoma and likely due to irritable bowel syndrome.
However, despite taking medication and probiotics, my symptoms have been intermittent.
Recently, since last September, I have been experiencing frequent burping, flatulence, and bloating.
In the last one to two months, my stools have been flat and narrow.
What could be the cause of this? The medication hasn't made much difference, and during a previous digital rectal exam, it was noted that there was only mild internal hemorrhoids.
Could there be any lesions in the colon? My last colonoscopy was around April 2020, and I was told to return in three years, but it has only been about two years since then.
Should I consider having a colonoscopy sooner? I am quite worried...
Thank you.
"Some clinics believe that the changes in stool shape to flat and narrow are related to irritable bowel syndrome..."

Denny, 30~39 year old female. Ask Date: 2022/02/27

Dr. Zhang Shuhao reply Surgery

Changes in stool shape caused by colorectal tumors are due to a narrowing of the intestinal lumen, which leads to the stool being squeezed through the constricted area, resulting in thinner stools.
If the obstruction becomes more severe, symptoms such as abdominal pain and diarrhea may occur.
At this stage, the stool may also be blood-streaked or appear brick-red due to friction with the tumor.
If the stool color is normal but defecation is more difficult, the flattened stool is usually caused by compression at the anal opening.
Increasing fluid intake and dietary fiber can help facilitate smoother bowel movements.
Generally, for polyp surveillance, if there is no family history or additional risk factors, follow-up can be done in 2 to 3 years.
However, if there are concerning abdominal symptoms, earlier examination can be arranged through outpatient consultation.

Reply Date: 2022/02/27

More Info

Understanding flat stool can be concerning, especially for someone with a history of colorectal issues. Flat or thin stools can be indicative of several underlying conditions, and it’s essential to understand the potential causes and when to seek medical advice.

Causes of Flat Stool
1. Dietary Factors: A diet low in fiber can lead to changes in stool consistency. Insufficient fiber intake can result in harder, more compact stools that may appear flat or thin. Increasing fiber intake through fruits, vegetables, and whole grains can help normalize stool shape.

2. Irritable Bowel Syndrome (IBS): Given your history of IBS, it’s possible that the flat stools are related to this condition. IBS can cause a variety of symptoms, including changes in bowel habits, abdominal pain, and bloating. The fluctuating nature of IBS can lead to episodes of diarrhea and constipation, which may affect stool shape.

3. Colon Obstruction: A more serious cause of flat stools can be a partial obstruction in the colon. This could be due to scar tissue, a tumor, or other growths that may not have been present during your last colonoscopy. An obstruction can change the way stool passes through the intestines, leading to thinner stools.

4. Inflammatory Conditions: Conditions such as colitis or Crohn’s disease can lead to inflammation in the intestines, which may affect stool consistency. If there is ongoing inflammation, it could contribute to changes in how your stool appears.

5. Polyps or Tumors: Although you have had polyps removed and have been monitored, any new growths or changes in existing polyps could potentially lead to changes in stool shape. This is particularly concerning if you have a history of adenomatous polyps.

When to Seek Medical Advice
Given your medical history and the recent changes in your stool, it is advisable to consult with your healthcare provider. Here are some specific situations where you should seek medical attention:
- Persistent Changes: If your flat stools persist for more than a few days or weeks, it’s essential to get evaluated.

- Accompanying Symptoms: If you experience additional symptoms such as significant abdominal pain, blood in your stool, unexplained weight loss, or changes in appetite, these could be signs of a more serious condition.

- Worsening Symptoms: If your symptoms worsen or you develop new symptoms, it’s crucial to seek medical advice promptly.

Follow-Up Colonoscopy
Regarding your concern about needing an earlier colonoscopy, it’s essential to discuss this with your doctor. Given your history of adenomatous polyps, your physician may recommend an earlier screening based on your current symptoms and any changes in your bowel habits. The standard recommendation for follow-up colonoscopy after polyp removal is typically every 3 to 5 years, depending on the type and number of polyps found. However, if you are experiencing new symptoms, your doctor may suggest an earlier evaluation.

Conclusion
In summary, flat stools can arise from various causes, including dietary factors, IBS, potential obstructions, and inflammatory conditions. Given your history of polyps and ongoing gastrointestinal symptoms, it’s crucial to maintain open communication with your healthcare provider. They can help determine the appropriate next steps, including whether an earlier colonoscopy is warranted. Remember, it’s always better to err on the side of caution when it comes to changes in bowel habits, especially with your medical history.

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