Bowel Issues: Constipation, Diarrhea, and Possible Causes

Hello, doctor. I have some intestinal issues I would like to discuss?

Hello, doctor.
I have a problem with constipation, so I have been taking laxatives.
However, over the past couple of months, my bowel movements have become a bit strange; sometimes I experience constipation, other times diarrhea, sometimes watery stools, sometimes small stools, and sometimes they return to normal size and a golden color.
In 2018, I underwent a colonoscopy, during which only a small internal hemorrhoid was found at the anal opening, and nothing else was abnormal.
I would like to ask the doctor if it is possible that I have a malignant tumor? Can a tumor develop within four years? Or could there be other factors? Currently, I consulted a doctor who mentioned irritable bowel syndrome, but the medication has not provided much improvement.
He also seems to discourage another colonoscopy, stating that since I had one four years ago, there may not be any changes.
Is it possible for there to be any lesions? Thank you, doctor!

A Q, 30~39 year old female. Ask Date: 2022/12/02

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Hello Mr.
A-Q, based on your symptoms, they are more indicative of irritable bowel syndrome (IBS).
However, if you are not experiencing significant improvement with medication, I recommend discussing with your treating physician whether further examinations are necessary.
As for tumor growth, the timeline can vary, and it is not possible to determine whether a tumor could form in four years.
Additionally, managing IBS requires not only medication but also lifestyle modifications.
Thank you for your inquiry.

Reply Date: 2022/12/02

More Info

Understanding bowel issues such as constipation, diarrhea, and abdominal pain can be quite complex, especially when symptoms fluctuate between different forms of bowel dysfunction. Based on the information provided, it seems you are experiencing a range of symptoms including constipation, diarrhea, and changes in stool consistency and size. These symptoms can be indicative of several underlying conditions, with Irritable Bowel Syndrome (IBS) being a primary consideration.

IBS is a functional gastrointestinal disorder characterized by recurrent abdominal pain or discomfort associated with changes in bowel habits. The symptoms can vary widely among individuals, leading to episodes of constipation, diarrhea, or alternating between both. The Rome IV criteria, which is the updated diagnostic standard for IBS, emphasizes that symptoms must be present for at least one day per week over the last three months, with associated changes in stool frequency or form.

Your history of a colonoscopy in 2018, which revealed only a small hemorrhoid, is reassuring but does not completely rule out the possibility of new developments. While it is uncommon for malignant tumors to develop within a four-year span without any other symptoms, it is not impossible. Factors such as family history, age, and the presence of alarming symptoms (like significant weight loss, blood in the stool, or severe abdominal pain) would warrant further investigation.

The fact that your doctor has suggested IBS as a diagnosis aligns with your symptoms, especially if you have experienced stress or dietary changes that could exacerbate the condition. Treatment for IBS typically focuses on symptom management, which may include dietary modifications (such as increasing fiber intake, avoiding trigger foods), stress management techniques, and medications tailored to your specific symptoms (e.g., laxatives for constipation, antidiarrheal agents for diarrhea).

If your current treatment regimen is not providing relief, it may be beneficial to revisit your healthcare provider to discuss alternative therapies. This could include trying different classes of medications, such as antispasmodics for abdominal pain or probiotics to help regulate gut flora. Additionally, cognitive-behavioral therapy (CBT) has shown promise in managing IBS symptoms by addressing the psychological components of the disorder.

Regarding the concern about a potential malignancy, if you are experiencing new or worsening symptoms, it may be prudent to have a follow-up colonoscopy, especially since it has been four years since your last one. While your doctor may feel that the risk is low, your peace of mind is important, and further investigation can help rule out any serious conditions.

In summary, while your symptoms are consistent with IBS, it is essential to maintain open communication with your healthcare provider about your concerns. If symptoms persist or worsen, advocating for further evaluation, including possibly repeating a colonoscopy, is a reasonable approach. Remember, managing bowel health often requires a multifaceted approach, including lifestyle changes, dietary adjustments, and sometimes medication, to achieve the best outcomes.

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