Colonoscopy Concerns: Symptoms, Anxiety, and Digestive Health

Colonoscopy-related issues?

Hello, doctor.
I am scheduled for a colonoscopy on Tuesday, but I do not have any symptoms.
Recently, I had been experiencing diarrhea, and the doctor suggested that I consider a colonoscopy.
I was hesitant at first, but I decided to go ahead with it, especially since there has been a trend of diseases occurring in younger individuals.
At that time, my stool had mucus, but it improved after taking medication.
The stool issues have been quite troubling for me; sometimes it is thin, about the size of a finger, and other times it is normal, ranging from the size of a five-dollar coin to a fifty-dollar coin, with lengths exceeding 15 centimeters.
What is considered normal stool? I do not have blood in my stool, but the upcoming colonoscopy has affected my mood, and I have been feeling anxious, which has led to some irregularities in my bowel movements.
Sometimes I have difficulty passing stool, and other times it comes out thin.
Could this be irritable bowel syndrome, or is it related to an intestinal disease? I am unsure whether to proceed with the colonoscopy, and I am feeling quite conflicted.
Could you please provide some clarity, doctor?

L, 20~29 year old female. Ask Date: 2012/03/25

Dr. Li Yongming reply Gastroenterology and Hepatology

Hello.
The early symptoms of colorectal cancer are quite subtle and generally include: 1.
Blood in the stool or black stools 2.
Changes in bowel habits without obvious reasons (such as persistent constipation or diarrhea) 3.
Weight loss 4.
Abdominal cramping or colonic pain 5.
A feeling of incomplete evacuation after a bowel movement 6.
Symptoms of anemia, such as cold extremities, fatigue, rapid heartbeat, shortness of breath, pale complexion, and dizziness.
However, having these symptoms does not necessarily mean one has colorectal cancer.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain or discomfort associated with changes in bowel habits for unknown reasons.
The term "functional disorder" refers to the absence of any identifiable organic disease based on current diagnostic tests.
It is a common gastrointestinal condition, affecting one in five people worldwide.
This condition impacts approximately 15% to 22% of the population in Western countries.
Although IBS can occur in men and women of any age, it is more prevalent in women from late adolescence to middle age.
Generally, in Western countries, the male-to-female ratio is about 1:2.
The prevalence seems to be somewhat lower in Southeast Asia; however, Taiwan's prevalence is comparable to that of Europe and the United States, at about 22%.
The notable difference is that the male-to-female ratio is relatively equal.

The diagnostic criteria for irritable bowel syndrome (Rome IV criteria) include:
- Experiencing abdominal discomfort or pain for at least 12 weeks in the past year (not necessarily consecutive), with at least two of the following features:
1.
Improvement of abdominal pain or discomfort after bowel movements
2.
Associated with a change in the frequency of bowel movements (increased or decreased)
3.
Associated with a change in stool form (constipation or diarrhea)
Additionally, one or more of the following symptoms must frequently occur to differentiate between the different types of IBS.
These symptoms do not have to be present, but the more symptoms that appear, the more likely the diagnosis is confirmed:
1.
Abnormal bowel frequency (more than 3 times per day or less than 3 times per week)
2.
Abnormal stool form (lumpy, hard, or loose, watery stools)
3.
Abnormal bowel movements (straining, urgency, or feeling of incomplete evacuation)
4.
Passage of mucus in the stool
5.
Abdominal bloating
Therefore, one of the differential diagnoses is to use a colonoscopy to rule out any organic lesions in the colon.
After all, these are two different diseases, and their management differs.

Reply Date: 2012/03/25

More Info

Colonoscopy is a common procedure used to examine the inner lining of the colon and rectum. It is often recommended for individuals experiencing gastrointestinal symptoms, such as persistent diarrhea, changes in bowel habits, or unexplained abdominal discomfort. Your concerns about the procedure, especially regarding discomfort and potential risks, are valid and shared by many patients.

Firstly, it is important to understand that while colonoscopy can cause some discomfort, advancements in medical technology have significantly improved the experience for patients. Many facilities now offer sedation options, including conscious sedation or even general anesthesia, which can help alleviate discomfort during the procedure. This means that while you may feel some pressure or cramping, you are unlikely to experience significant pain. If you are particularly anxious about the procedure, discussing your concerns with your healthcare provider can help you explore options for sedation that may make the experience more comfortable.

Regarding the risks associated with colonoscopy, they are generally low. The most common complications include bleeding, especially if a biopsy is taken or a polyp is removed, and perforation of the colon, which is rare. The overall risk of serious complications is estimated to be less than 1%. It is crucial to weigh these risks against the potential benefits of the procedure, especially if you have concerning symptoms or a family history of colorectal issues.

In your case, you mentioned experiencing changes in your bowel habits, including episodes of diarrhea and the presence of mucus in your stool. These symptoms can be indicative of conditions such as irritable bowel syndrome (IBS), which is often exacerbated by stress and dietary factors. IBS is characterized by a combination of abdominal pain and altered bowel habits, including diarrhea and constipation. While IBS is not considered a serious condition, it can significantly impact your quality of life and may warrant further investigation to rule out other underlying issues.

The size and consistency of your stool can vary widely and still be considered normal. Generally, healthy stool should be well-formed, easy to pass, and vary in size. The presence of mucus can be normal, especially if you are experiencing gastrointestinal distress. However, if you notice persistent changes, it is essential to consult with a healthcare provider.

Your anxiety about the upcoming colonoscopy is understandable, especially given the prevalence of gastrointestinal diseases in younger populations. It is essential to address this anxiety, as stress can exacerbate gastrointestinal symptoms. Engaging in relaxation techniques, such as deep breathing exercises, meditation, or gentle physical activity, may help alleviate some of your stress leading up to the procedure.

Ultimately, the decision to proceed with the colonoscopy should be based on a thorough discussion with your healthcare provider, who can help you understand the necessity of the procedure in light of your symptoms and medical history. If your doctor believes that the benefits of the colonoscopy outweigh the risks, it may be a prudent step to take for your digestive health.

In conclusion, while the thought of undergoing a colonoscopy can be daunting, it is a valuable diagnostic tool that can provide critical insights into your gastrointestinal health. By addressing your concerns with your healthcare provider and considering sedation options, you can approach the procedure with greater confidence and peace of mind. Remember, taking proactive steps in managing your digestive health is essential, and a colonoscopy may be an important part of that journey.

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