Concerns About Colonoscopy Findings: What You Need to Know

Q: Concerns About Colonoscopy Findings: What You Need to Know

Hello, Sir： 1. You should trust your physician's judgment, but there are indeed exceptions in the world. 2. If you have no symptoms, there is no need for medication treatment. 3. Hemorrhoids are vascular tissues at the anal opening, and everyone has them to so

Colonoscopy issues?

Hello,
My wife (25 years old) has been experiencing symptoms such as constipation, abdominal pain, and blood in her stool for the past year.
Her stools are usually thin and soft, and she often alternates between constipation and diarrhea.
Despite increasing her water intake, eating more fruits and vegetables, and exercising, her symptoms have not improved.
She also frequently experiences bloating and nausea after meals.
Last week, after seeing a doctor, we decided to proceed with a colonoscopy.
I accompanied her during the procedure and observed everything closely.
Near the distal end of the colon, I noticed some yellowish mucus, and I saw a round, relatively large "object" on the left upper side of the colon wall.
Its surface was the same yellowish color as the mucus and was reflective, but it was a clearly defined "whole object" sticking to the left upper colon wall, unlike the other mucus that was dispersed below.
The nurse also saw it and asked the doctor about it, who responded that it was mucus.
However, I am concerned that the doctor might not have noticed that "object" or may have missed it while looking at the screen, as there was also mucus further along in that area.
The more I think about it, the more worried I become...
1.
Is it possible that the "object" is just mucus? Could it be that the doctor missed it while looking at the screen, or could it be a polyp or tumor covered by mucus that the doctor did not notice?
2.
There were some areas in the proximal colon with streaks of blood, and the doctor mentioned some superficial inflammation, but no treatment or medication was prescribed.
What treatment, if any, is necessary? Could this be the cause of the symptoms mentioned in the first paragraph?
3.
There is a small hemorrhoid near the anal area (the doctor only mentioned this after we inquired about the blood in the stool), but no medication or treatment was provided.
Could this be the cause of the symptoms mentioned above?
4.
The doctor noted some dark areas in the rectum, attributing them to excessive use of laxatives or dietary supplements.
Could this contribute to alternating constipation and diarrhea?
5.
Is it necessary to undergo another colonoscopy? Does health insurance cover two procedures within a short period? What is the minimum interval required between them? The doctor did not provide any solutions or treatments for the symptoms in the first paragraph (which are quite bothersome).
Should we see another doctor? I understand that I should trust the physician, but I have read that the misdiagnosis rate for colorectal cancer in young people is quite high, so I am genuinely worried.
Thank you for your patience in answering these questions!

L, 30~39 year old female. Ask Date: 2015/04/02

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, Sir: 1.
You should trust your physician's judgment, but there are indeed exceptions in the world.
2.
If you have no symptoms, there is no need for medication treatment.
3.
Hemorrhoids are vascular tissues at the anal opening, and everyone has them to some extent; if there is no bleeding or symptoms, treatment is not necessary.
4.
Alternating conditions are due to irregular intestinal motility (Irritable Bowel Syndrome), and as long as symptoms are controlled, it is sufficient.
Frequent use of laxatives may lead to black deposits in the colon, but it does not harm health.
5.
It is recommended to have a fecal occult blood test once a year; if there is a positive occult blood reaction, then a colonoscopy should be performed.
Changhua Hospital cares about your health.
Chen Shidian

Reply Date: 2015/04/02

More Info

It sounds like your wife has been experiencing a range of gastrointestinal symptoms that are understandably concerning. Based on the information you've provided regarding her colonoscopy findings and symptoms, let's address your questions systematically.

1. The "thing" you saw during the colonoscopy: It is possible that what you observed was indeed a piece of mucus or a stool residue, especially if it was yellowish and reflective. However, it is also conceivable that it could have been a polyp or another abnormal growth that was obscured by mucus. Colonoscopies can sometimes miss small lesions, particularly if they are not clearly visible. If you remain concerned, it may be worthwhile to discuss this with the gastroenterologist who performed the procedure, as they can provide more context based on the images and their observations.

2. The superficial inflammation and blood: The presence of blood and inflammation in the colon could be related to several factors, including the alternating constipation and diarrhea your wife is experiencing. This pattern can lead to irritation of the intestinal lining, which may cause inflammation and bleeding. If the doctor did not prescribe any treatment, it may be because they believe the inflammation is mild and could resolve with dietary changes and increased hydration. However, if symptoms persist or worsen, a follow-up consultation would be advisable to explore treatment options.

3. The hemorrhoids: Hemorrhoids can certainly cause blood in the stool, especially if they are inflamed or thrombosed. They are a common cause of rectal bleeding and can be exacerbated by straining during bowel movements, which may occur with constipation. If the doctor did not recommend treatment, it might be because the hemorrhoids are not severe. However, if your wife continues to experience bleeding, it would be wise to consult a healthcare provider for potential treatment options, which may include topical medications or lifestyle modifications.

4. The dark area in the rectum: The discoloration noted by the doctor could indeed be a result of excessive use of laxatives or certain supplements. Overuse of laxatives can lead to dependency and may disrupt normal bowel function, contributing to the cycle of constipation and diarrhea. It is essential to use laxatives judiciously and under medical supervision to avoid such complications.

5. Need for repeat colonoscopy: Whether a repeat colonoscopy is necessary depends on the findings and your wife's ongoing symptoms. Generally, if there are no significant findings and symptoms persist, a follow-up with a gastroenterologist is recommended rather than an immediate repeat colonoscopy. Insurance coverage for repeat procedures can vary, but typically, guidelines suggest waiting at least 5 to 10 years for routine screenings unless there are concerning findings that warrant earlier follow-up. If your wife’s symptoms are significantly impacting her quality of life, it would be prudent to seek another opinion or follow-up with her healthcare provider sooner rather than later.

In conclusion, while it is essential to trust your healthcare provider, it is equally important to advocate for your health and seek clarification when needed. If your wife's symptoms are not improving or if you have lingering concerns about the findings from the colonoscopy, do not hesitate to schedule a follow-up appointment. It is always better to address these issues proactively, especially given the potential for serious conditions like colorectal cancer, even in younger individuals.

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