Gastrointestinal Symptoms: When to Consider a Colonoscopy

Continuation of question #187758?

Hello Doctor, I previously inquired about issues related to bloating and changes in stool consistency (from thick to thin) (#187758), and here is the link: https://adoctor.tw/article/187758.
After starting my job, I reviewed my annual health check-up reports and noticed that, except for the year 2019, my average red blood cell volume has been consistently decreasing over the past three years, accompanied by a continuous increase in platelet count:
- 2017: Average red blood cell volume 82.7, Platelet count 350
- 2018: Average red blood cell volume 82.0, Platelet count 341
- 2019: Average red blood cell volume 82.1, Platelet count 383
- 2020: Average red blood cell volume 79.8, Platelet count 410
Additionally, my health check-up report at the end of last year was the first to note a potential for iron deficiency or thalassemia.
I later found online that if symptoms such as bloating, belching, flatulence, diarrhea, and alternating constipation are present alongside anemia, it could indicate gastrointestinal bleeding or colon cancer.
Recently, I have also started experiencing diarrhea (1 to 4 soft stools per day), and at night I feel the urge to defecate, but after two attempts, only gas is expelled.
It takes three or four attempts before I can pass soft, formed, or mushy stools.
The frequency of flatulence has also increased, and I am very concerned that there may be something wrong in my intestines, or that my anxiety is causing the soft stools.

This month, I have been diligently monitoring the shape and color of my stools.
Currently, there are no visible signs of black or red stools or blood in my stools, and I have not experienced significant weight loss.
However, the bloating and belching after meals persist.
I would like to ask if this situation warrants a colonoscopy.
Would a fecal occult blood test alone be potentially inaccurate? Thank you, Dr.
Chen.

YUU, 20~29 year old female. Ask Date: 2022/10/23

Dr. Chen Shidian reply Gastroenterology and Hepatology

First, it's important to understand that all tests have a limit to their accuracy.
While colonoscopy is the most precise, it is possible for all tests to return negative results.
Therefore, it is medically logical (and often a standard for health insurance review) to first arrange preliminary tests → follow-up → re-testing → and then proceed to more invasive examinations.
However, this process can be time-consuming and may cause anxiety among the public.
This perspective is for your consideration, and actual arrangements can be discussed with your attending physician (such as opting for a self-paid colonoscopy).

Reply Date: 2022/10/23

More Info

When it comes to gastrointestinal symptoms, particularly those involving changes in bowel habits, abdominal pain, and signs of potential anemia, it is crucial to approach the situation with a thorough understanding of the possible underlying causes. Your symptoms, including abdominal bloating, alternating diarrhea and constipation, and the presence of anemia, warrant careful consideration and potentially further investigation, such as a colonoscopy.

Understanding Your Symptoms
1. Anemia and Blood Tests: The decrease in your red blood cell volume (mean corpuscular volume, MCV) alongside an increase in platelet count could suggest several conditions, including iron deficiency anemia or thalassemia (Mediterranean anemia). Iron deficiency anemia can often be linked to gastrointestinal bleeding, which may not always present with visible blood in the stool. The fact that you have experienced changes in your blood parameters over the years should not be overlooked.

2. Gastrointestinal Symptoms: The combination of bloating, flatulence, and changes in stool consistency (from formed to loose stools) can indicate a functional gastrointestinal disorder, such as irritable bowel syndrome (IBS). However, these symptoms can also be associated with more serious conditions, including inflammatory bowel disease (IBD) or colorectal cancer, especially given your concerns about potential gastrointestinal bleeding.

3. Colonoscopy Consideration: A colonoscopy is a valuable diagnostic tool that allows for direct visualization of the colon and rectum. It can help identify polyps, tumors, and areas of inflammation or bleeding. Given your symptoms, particularly the presence of anemia and changes in bowel habits, a colonoscopy is advisable. It is especially important if you have a family history of colorectal cancer or if your symptoms persist or worsen.

4. Fecal Occult Blood Test: While a fecal occult blood test (FOBT) can be useful for screening for hidden blood in the stool, it is not definitive. False negatives can occur, especially if the bleeding is intermittent or if the test is not performed correctly. Therefore, relying solely on this test may not provide a complete picture of your gastrointestinal health.

Recommendations
- Consult a Gastroenterologist: Given your symptoms and blood test results, it is essential to consult a gastroenterologist. They can assess your situation comprehensively and determine the necessity of a colonoscopy based on your clinical presentation and history.

- Consider a Colonoscopy: If your doctor recommends it, a colonoscopy can provide critical insights into your gastrointestinal health. It is a safe procedure, and while there may be some discomfort, it is generally well-tolerated. The benefits of identifying any potential issues far outweigh the temporary discomfort associated with the procedure.

- Monitor Your Symptoms: Keep a detailed record of your symptoms, including the frequency and consistency of your bowel movements, any associated pain, and dietary habits. This information will be invaluable for your healthcare provider in making an accurate diagnosis.

- Dietary Adjustments: In the meantime, consider dietary changes that may alleviate some of your symptoms. A diet rich in fiber, adequate hydration, and avoidance of known irritants (such as caffeine, alcohol, and spicy foods) may help manage bloating and irregular bowel habits.

Conclusion
In summary, your symptoms, particularly the combination of anemia, changes in bowel habits, and gastrointestinal discomfort, suggest that further evaluation is warranted. A colonoscopy is a prudent step in ruling out serious conditions and ensuring your gastrointestinal health. Do not hesitate to seek medical advice, as early detection and intervention can significantly improve outcomes in gastrointestinal diseases.

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