Irregular Bowel Movements: When to Seek Medical Advice

Bowel issues

Hello Doctor, I am in my 20s and I am not sure if this has been the case since childhood or if I have only recently noticed it.
I have found that my bowel movements are never in the shape of a banana or sausage.
I often feel the urge to use the bathroom multiple times a day (2-3 times, sometimes more).
When I feel the need to defecate, sometimes I only pass gas, and other times I experience fecal leakage (after finishing, I usually feel relieved, so I don't think there is an issue with urgency or heaviness).
I remember having constipation frequently as a child, where I could feel tearing at the anal opening and my stools were hard and black, sometimes even clogging the toilet.
A few months ago, I noticed a significant amount of bright red blood on the toilet paper after wiping, but this issue resolved itself after a few weeks.
Recently, I have changed my diet to include a lot of fruits, and I believe I am drinking enough water; however, I do enjoy coffee and drink one to two cups a day.

I have noticed that my stools are never in a long, cylindrical shape.
Although the color does not appear abnormal, they look scattered, like several stones mixed together, but they are not hard and are easy to pass.
Subjectively, it feels like they were originally connected but easily break apart as they pass through the anal opening, resulting in a lumpy appearance.
I almost always have two to three bowel movements a day, and I am somewhat concerned that this could be a sign of something serious like cancer.
I previously consulted a doctor, but he told me not to worry and did not take any further action.

I would like to ask if this type of stool pattern is clinically normal for me, given that it is loose and irregular, with about 1-3 bowel movements per day.
I have not observed any significant abdominal pain, blood in the stool, or changes in weight.
Should I consider further examinations, such as a colonoscopy? I have been using the following medications long-term: Sertraline, Clonazepam, Doxycycline, Minocycline, and antihistamines.
Thank you for your assistance.

Student J, 20~29 year old female. Ask Date: 2023/05/11

Dr. Chen Shidian reply Gastroenterology and Hepatology

It is just a personal bowel habit and falls within the normal range, so there is no need to worry.
If anxiety persists, a stool occult blood test can be performed.

Reply Date: 2023/05/11

More Info

When it comes to irregular bowel movements, it's essential to understand that the characteristics of your stool can provide significant insights into your gastrointestinal health. Based on your description, it seems that you experience frequent bowel movements, often with a stool consistency that is not typical. You mentioned that your stools are not in the form of a banana or sausage but rather appear fragmented, resembling small stones. This can be indicative of several underlying issues, and it is wise to consider a thorough evaluation.

Firstly, the fact that you have experienced hard, black stools in the past, which caused pain and even bleeding, is concerning. Black stools can often indicate the presence of blood that has been digested, which may suggest bleeding in the upper gastrointestinal tract. The presence of blood on toilet paper after bowel movements, even if it has since resolved, should not be overlooked. It is crucial to monitor any recurrence of this symptom, as it could indicate conditions such as hemorrhoids, anal fissures, or more serious gastrointestinal issues.

Your current bowel habits, characterized by multiple daily bowel movements and a loose stool consistency, could be influenced by various factors, including diet, hydration, and possibly the medications you are taking. While you have made dietary changes to include more fruits and maintain hydration, coffee consumption can sometimes have a laxative effect, leading to more frequent bowel movements. Additionally, certain medications, particularly those affecting the central nervous system like Sertraline and Clonazepam, can influence bowel habits and gastrointestinal motility.

In clinical practice, the Bristol Stool Chart is often used to classify stool types, ranging from type 1 (hard lumps) to type 7 (liquid). Your description suggests that your stools may fall between types 4 (smooth and soft) and 5 (soft blobs with clear-cut edges), which can be considered on the softer side of normal. However, the fragmentation you describe could indicate a lack of proper muscle coordination during bowel movements or insufficient fiber intake, despite your fruit consumption.

Given your history of constipation and the potential for underlying issues, it is advisable to seek further medical evaluation. While your previous consultation may have reassured you, the persistence of your symptoms warrants a more in-depth investigation. A colonoscopy may be recommended to rule out any structural abnormalities, polyps, or other gastrointestinal conditions that could be contributing to your symptoms. It's also essential to discuss your medication regimen with your healthcare provider, as some medications can lead to gastrointestinal side effects.

In summary, while your current bowel habits may not immediately suggest a severe condition, the history of bleeding, pain, and changes in stool consistency should not be ignored. It is essential to maintain open communication with your healthcare provider, consider a referral to a gastroenterologist, and possibly undergo further testing to ensure your gastrointestinal health is thoroughly assessed. Regular monitoring and proactive management of your symptoms can help prevent complications and improve your overall well-being.

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