Abnormal Stool and When to Consider a Colonoscopy - Gastroenterology and Hepatology

Abnormal stool, colonoscopy?

Hello, doctor.
About three years ago, I underwent a colonoscopy, and the results were generally normal, except for a 0.5 cm hyperplastic polyp in the sigmoid colon that was removed and tested as benign.
Additionally, I have a problem with internal hemorrhoids.
Last year, I had another colonoscopy, but it only reached the transverse colon, and the results were normal with no abnormalities, although the internal hemorrhoids recurred.
Today, I noticed a small amount of mucus and blood at the end of my stool.
Could this be due to the internal hemorrhoids? The rest of the stool is normal in quantity and frequency, occurring daily.
I would like to know if I need to undergo another colonoscopy and how long I should wait before having one again.

Jie, 30~39 year old female. Ask Date: 2015/05/06

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, hyperplastic polyps are benign and generally do not undergo malignant transformation.
If there is a recurrence of blood in the stool or fecal occult blood, further examination can certainly be considered.
It is best to perform a complete colonoscopy of the entire colon; if that proves difficult, a barium enema can be added, or a painless colonoscopy can be chosen, as the success rate for a thorough examination is higher.
Wishing you peace and health.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Department of Gastroenterology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/05/06

More Info

When it comes to understanding abnormal stool and determining whether a colonoscopy is necessary, several factors must be considered, especially in the context of your medical history and current symptoms. Based on your previous colonoscopy results and the recent changes in your bowel habits, let's break down the situation.

Understanding Your Symptoms
You mentioned experiencing a small amount of mucus and blood in your stool, particularly at the end of a bowel movement. This could indeed be related to your history of internal hemorrhoids, which can cause bleeding, especially if there is straining during bowel movements. Hemorrhoids are a common cause of rectal bleeding and can lead to the presence of blood or mucus in the stool. However, any new or persistent changes in bowel habits, especially the presence of blood, should be taken seriously.

Previous Colonoscopy Findings
Your last colonoscopy, which was performed about a year ago, showed no abnormalities up to the transverse colon, and you had a benign polyp removed previously. The fact that you have a history of a hyperplastic polyp and internal hemorrhoids is important, as it indicates that you are at a slightly higher risk for colorectal issues, although your previous findings were reassuring.

When to Consider Another Colonoscopy
Given your current symptoms of mucus and blood in the stool, it is advisable to consult with your healthcare provider about the need for another colonoscopy. The general recommendation for surveillance colonoscopy after the removal of a benign polyp is typically every 5 to 10 years, depending on the type and number of polyps found. However, if you experience new symptoms such as rectal bleeding, changes in stool consistency, or abdominal pain, it may warrant an earlier examination.

Factors to Discuss with Your Doctor
1. Frequency of Symptoms: If the mucus and blood are occasional and you are not experiencing any other alarming symptoms (like significant weight loss, severe abdominal pain, or changes in bowel habits), it may be reasonable to monitor the situation. However, if these symptoms persist or worsen, further evaluation is necessary.

2. Family History: If there is a family history of colorectal cancer or other gastrointestinal diseases, this may influence the decision to perform a colonoscopy sooner rather than later.

3. Other Symptoms: Consider any other gastrointestinal symptoms you may be experiencing, such as changes in appetite, weight loss, or changes in bowel habits (like diarrhea or constipation).

4. Physical Examination: Your doctor may perform a physical examination, including a digital rectal exam, to assess for any abnormalities.

Conclusion
In summary, while your previous colonoscopy results were normal, the presence of blood and mucus in your stool should not be ignored. It is essential to have an open discussion with your healthcare provider about your symptoms and whether a repeat colonoscopy is warranted. They may recommend a colonoscopy sooner than the typical surveillance schedule based on your current symptoms and medical history. Regular follow-ups and monitoring are crucial in managing your gastrointestinal health, especially with your history of polyps and hemorrhoids.

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