Do You Need a Colonoscopy? Symptoms and Concerns

Is a colonoscopy necessary?

Hello, Dr.
Ke! About a year ago, I often experienced hard stools at the beginning of my bowel movements.
Sometimes, the stool was soft the day before, but other times, it was very dry the next day, which frequently led to anal fissures with bright red blood and splattering.
This may have resulted in habitual anal fissures, making it easy for the anal area to tear and bleed bright red whenever the stool was slightly larger or drier.
Recently, over the past two months, my bowel movement frequency has increased to about 2-3 times a day, and I have been passing stool each time.
The diameter of my stools seems to have decreased, but it varies with each bowel movement.
In the last three days, I've been experiencing gastrointestinal discomfort, with soft stools and frequent urges to defecate (3-4 times a day), producing small and scant stools.
Taking "Zhenglu Pills" and "Biaofeiming" has not been very effective.
I visited a gastroenterology clinic and received medication, which has shown slight improvement, but the effect has been slow and I have not fully recovered.
(In the past two years, I have had negative results for fecal occult blood tests every six months, but not immune-type tests.)
I would like to ask:
1.
Besides issues related to the colon and rectum, could the decrease in stool diameter also be related to anal fissures (narrowing of the anal canal)? - (I have undergone an anoscopy, and the doctor mentioned mild anal fissures and hemorrhoids, advising that surgery is not necessary and that topical medication is sufficient.)
2.
Does frequent bowel movements and soft stools affect stool diameter?
3.
Is my recent gastrointestinal discomfort simply due to gastroenteritis, or should I undergo a colonoscopy?
Thank you, doctor, for clarifying my concerns and alleviating my recent anxieties!

Yourenzhe, 40~49 year old female. Ask Date: 2012/08/31

Dr. Ke Fangxu reply Surgery

Anal fissures can indeed cause a decrease in the diameter of stools, and factors such as the frequency of bowel movements and stool consistency can also affect stool appearance.
Prolonged straining during bowel movements can lead to thinner stools as well.
In summary, there are many factors that can alter stool appearance.
For individuals over the age of 40 experiencing these issues, it is advisable to undergo an immunochemical fecal occult blood test.
If there are significant concerns affecting daily life, a colonoscopy may also be warranted.

Reply Date: 2012/08/31

More Info

When considering whether you need a colonoscopy, it's essential to understand the symptoms you are experiencing and the potential underlying issues they may indicate. Based on your description, you have been dealing with hard stools, rectal bleeding, and changes in bowel habits, which can be concerning and warrant further investigation.

1. Changes in Stool Diameter and Anal Fissures: You mentioned that your stool diameter has decreased and that you have experienced anal fissures. It is important to note that a decrease in stool size can sometimes be associated with rectal or colon issues, such as strictures or masses. However, anal fissures can also cause discomfort and lead to changes in bowel habits, as the pain associated with passing hard stools may lead you to alter your bowel movements. The presence of fissures and hemorrhoids, as noted by your physician, can indeed contribute to the sensation of narrowing in the anal canal, which may affect stool passage.

2. Impact of Frequent and Soft Stools on Stool Diameter: Frequent bowel movements and softer stools can also influence stool shape and size. When stools are softer, they may not retain their shape as firmly as harder stools, which can lead to variations in diameter. However, if you are experiencing a significant change in your bowel habits, such as an increase in frequency and a notable change in stool consistency, this could indicate an underlying gastrointestinal issue that may need to be evaluated further.

3. Gastrointestinal Discomfort and the Need for a Colonoscopy: Given your recent gastrointestinal discomfort and changes in bowel habits, it is prudent to consider a colonoscopy. While your past stool occult blood tests have been negative, these tests do not rule out all potential issues within the colon. A colonoscopy can provide a direct view of the colon and rectum, allowing for the identification of polyps, inflammation, or other abnormalities that may not be detected through non-invasive tests. Additionally, given your symptoms of increased frequency of bowel movements and the presence of soft stools, a colonoscopy can help rule out conditions such as inflammatory bowel disease (IBD) or other structural abnormalities.

In summary, while some of your symptoms may be attributed to anal fissures and hemorrhoids, the combination of changes in stool diameter, increased frequency of bowel movements, and gastrointestinal discomfort suggests that a colonoscopy may be warranted. It is essential to have a thorough discussion with your healthcare provider about your symptoms and concerns. They can help determine the appropriate next steps, which may include a colonoscopy or other diagnostic tests to ensure your gastrointestinal health is adequately assessed. Remember, early detection and intervention are key to managing potential gastrointestinal issues effectively.

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