Digestive Issues: Insights on Bowel Health and Treatment Options

Gastrointestinal issues, etc?

Hello Dr.
Lee: After I have a bowel movement, I sometimes notice that I can wipe some stool with toilet paper after a while, which seems to indicate that I am not fully emptying my bowels (without blood in the stool).
I have visited the hospital, and the doctor believes that it may be due to insufficient dietary fiber intake leading to poor gastrointestinal function.
I was prescribed two medications, Kascoal and Mopride.
The doctor mentioned that if there is no improvement after taking the medication, a colonoscopy may be necessary.
I would like to know if a colonoscopy will cause any discomfort or pain.
Additionally, can I have an abdominal ultrasound done? I would also appreciate any insights and suggestions based on the symptoms I have described.
Thank you very much!

Lai, 20~29 year old female. Ask Date: 2011/10/22

Dr. Li Yongming reply Gastroenterology and Hepatology

Many patients in gastroenterology clinics report the symptom of incomplete bowel evacuation, which is often benign in nature.
Possible causes include: 1.
Insufficient fiber intake, leading to poorly formed (non-shaped) stools, or poor water absorption in the intestines, resulting in excessive water retention in the colon and producing watery stools.
2.
Irritable Bowel Syndrome (IBS), a condition characterized by abnormal intestinal motility due to multiple factors.
This includes autonomic nerve conduction issues, abnormal defecation reflexes, or heightened sensitivity of intestinal mucosal cells, as well as psychological stress, premenstrual syndrome, and other related factors.
IBS is also referred to as neurogenic colon, spastic colon, mucous colitis, or spastic colitis; however, there are currently no direct diagnostic tools for IBS, and it is diagnosed only after excluding other organic bowel diseases, which can be time-consuming.
Treatment is symptomatic and varies in effectiveness among individuals, with recent studies even suggesting that placebos can have notable effects.
3.
Colorectal cancer or polyp symptoms.
The Department of Health and the National Health Administration are actively promoting fecal occult blood testing as the first-line screening for colorectal cancer.
However, changes in bowel habits, weight loss, and persistent feelings of incomplete evacuation are potential symptoms of colorectal cancer.
The medication Kascoal prescribed by your physician works by reducing surface tension to eliminate gas bubbles in the gastrointestinal tract, thereby alleviating bloating discomfort.
Mopride, on the other hand, is primarily a medication that promotes gastric emptying and increases intestinal motility.
If symptoms do not improve after using these medications, colorectal cancer or polyps must be considered in the differential diagnosis, and a colonoscopy may be necessary.
Abdominal ultrasound is limited in its diagnostic value for the colon due to air interference, making it less useful.
Alternative methods for screening colorectal cancer or polyps, aside from colonoscopy, include: 1.
Lower gastrointestinal barium studies: A contrast agent (barium) is introduced into the colon via the rectum, and X-ray imaging is performed to visualize the colon wall.
The patient may need to change positions during the procedure to avoid overlapping or missed images.
However, the diagnostic rate is lower, and feces can be misinterpreted as cancer or polyps.
This method can only diagnose but not treat, and it is covered by health insurance.
2.
Multi-slice computed tomography (CT) colonography (virtual colonoscopy): This advanced imaging technique uses multi-slice CT scans to create three-dimensional images or multi-directional reconstructions to diagnose conditions.
However, it may have limitations in detecting lesions smaller than 1 cm, and like barium studies, it can only diagnose but not treat.
There are few hospitals in Taiwan with such advanced and expensive equipment, and it is not covered by health insurance.
In contrast, colonoscopy remains a cost-effective and efficient examination that can also provide therapeutic interventions, with health insurance coverage.
If a removable polyp is encountered, it can be excised during the procedure, resolving the issue.
If colorectal cancer is not removable, biopsies can be taken, and the location noted to assist in subsequent surgical procedures.
The overall success rate for colonoscopy is over 90%, with failures typically due to operator skill (less common), anatomical abnormalities (e.g., excessive bowel curvature), adhesions (related to previous surgeries), or poor bowel preparation (the most common reason, often due to patient non-compliance).
The drawbacks include a statistical risk of complications worldwide, such as bowel perforation or bleeding, which mostly occur during further interventions like electrocautery or polyp removal.
Discomfort during the procedure is common due to air insufflation in the colon, and the level of discomfort varies among individuals; most colonoscopies can be completed within 30 minutes.
There is also a "no-pain" colonoscopy option, which involves anesthesia during the procedure; however, the anesthesia portion is not covered by health insurance, with costs ranging from NT$2,500 to NT$10,000, depending on the hospital or health examination center.
Anesthesia carries its own risks.
In the United States, anesthesia is routinely used, but the cost of a single colonoscopy ranges from $1,000 to $1,500, making it expensive.
In Japan, the approach is to first perform a standard colonoscopy, and if the patient experiences pain (approximately 10% of cases), a note is made to pause the examination and schedule a "no-pain" colonoscopy for the next visit.
Most gastroenterologists in Taiwan prefer the latter approach.
This information is provided for your reference.

Reply Date: 2011/10/22

More Info

Hello! Thank you for reaching out with your concerns regarding bowel health. Based on your description, it seems you are experiencing symptoms that could be related to inadequate bowel emptying, which can often be linked to dietary fiber intake and digestive health.

Firstly, it’s important to understand that the sensation of incomplete evacuation after a bowel movement can be quite common and may be influenced by several factors, including diet, hydration, and overall gastrointestinal function. In your case, your physician has suggested that insufficient dietary fiber may be contributing to your digestive issues. Fiber plays a crucial role in promoting regular bowel movements by adding bulk to the stool and facilitating its passage through the intestines. A diet rich in fruits, vegetables, whole grains, and legumes can significantly improve bowel health.

The medications you mentioned, Kascoal and Mopride, are often prescribed to help manage digestive issues. Kascoal is typically used to alleviate symptoms of bloating and discomfort, while Mopride can help enhance gastrointestinal motility, making it easier for food to move through the digestive tract. If these medications do not lead to improvement, your doctor may recommend a colonoscopy to rule out any underlying conditions.

Regarding your question about the discomfort associated with a colonoscopy, it’s understandable to have concerns. While the procedure itself can cause some discomfort, it is generally well-tolerated. Most patients receive sedation, which helps minimize any pain or discomfort during the examination. After the procedure, some individuals may experience mild cramping or bloating, but these symptoms usually resolve quickly. It’s essential to discuss any concerns you have with your healthcare provider, as they can provide reassurance and information tailored to your specific situation.

An abdominal ultrasound can also be a useful diagnostic tool. It is a non-invasive procedure that can help visualize the organs in your abdomen, including the liver, gallbladder, and intestines. While it may not directly assess bowel function, it can help identify any structural abnormalities that might be contributing to your symptoms.

In addition to medical interventions, there are several lifestyle changes you can implement to improve your bowel health:
1. Increase Fiber Intake: Aim for at least 25-30 grams of dietary fiber per day. Incorporate a variety of fiber-rich foods into your diet, such as fruits (like apples and berries), vegetables (like broccoli and carrots), whole grains (like oats and brown rice), and legumes (like beans and lentils).

2. Stay Hydrated: Drinking plenty of water is crucial for digestive health. Aim for at least 8 cups (64 ounces) of water daily, and consider increasing your intake if you are consuming more fiber.

3. Regular Physical Activity: Engaging in regular exercise can help stimulate bowel function. Aim for at least 150 minutes of moderate aerobic activity each week, along with strength training exercises.

4. Establish a Routine: Try to set aside time each day for bowel movements, especially after meals when the digestive system is most active. This can help train your body to have regular bowel movements.

5. Manage Stress: Stress can significantly impact digestive health. Consider incorporating relaxation techniques such as yoga, meditation, or deep-breathing exercises into your daily routine.

6. Monitor Your Symptoms: Keep a diary of your bowel habits, dietary intake, and any symptoms you experience. This information can be valuable for your healthcare provider in determining the best course of action.

In conclusion, while your symptoms may be concerning, there are several avenues for investigation and management. Collaborating closely with your healthcare provider will ensure that you receive the most appropriate care tailored to your needs. If you have further questions or concerns, don’t hesitate to reach out for additional guidance. Wishing you the best on your journey to improved digestive health!

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