Abnormal Bowel Habits: When to Seek Further Evaluation

Abnormal bowel movements?

Hello Dr.
Chen, I have had persistent issues with bowel movements since childhood, often experiencing constipation, but without any other symptoms.
Last October, I sought medical attention due to blood in my stool, and the doctor diagnosed me with internal hemorrhoids.
To ease my concerns, I also underwent a colonoscopy, which showed normal results.
However, at the end of May this year, I noticed a slight recurrence of blood in my stool, along with increased bowel sounds and flatulence.
The frequency of constipation and diarrhea has also increased compared to my normal bowel habits, and sometimes I feel the urge to have a bowel movement even when I don’t actually need to go.
After researching my symptoms online, I found that they resemble irritable bowel syndrome (IBS).
I would like to know if I need to undergo further examinations.
The doctor who performed the colonoscopy previously told me that the results were normal and that I wouldn’t need another one until I turn 30.
Thank you, doctor.

Gao's, 20~29 year old female. Ask Date: 2015/06/22

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, strictly speaking, this can be referred to as constipation-predominant irritable bowel syndrome, commonly known as habitual constipation.
As for occasional diarrhea, it is not a major concern.
The current presence of blood in the stool is likely caused by internal hemorrhoids, and immediate colonoscopy is not recommended.
It is advised to take a warm sitz bath before using suppositories, along with increasing water intake, consuming more fruits and vegetables, and avoiding irritating and fried foods.
If there is no improvement, please consult a colorectal surgeon.
Wishing you health and safety.
Sincerely, Dr.
Chen Chih-Feng, Attending Physician, Gastroenterology Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2015/06/22

More Info

Understanding abnormal bowel habits is crucial for maintaining gastrointestinal health. Your symptoms, including a history of constipation, recent episodes of blood in the stool, increased bowel sounds, and alternating between constipation and diarrhea, warrant careful consideration. Given your previous diagnosis of internal hemorrhoids and a normal colonoscopy, it’s understandable to feel concerned about the recurrence of blood in your stool and changes in your bowel habits.

Firstly, let’s clarify what constitutes abnormal bowel habits. Generally, a significant change in the frequency, consistency, or appearance of stools can be classified as abnormal. For instance, normal bowel habits can range from three times a week to three times a day. Symptoms such as persistent diarrhea, constipation, or the presence of blood in the stool are red flags that should prompt further evaluation.

In your case, the presence of blood in the stool is particularly concerning, even if it is described as "light." Blood can indicate various conditions, from benign issues like hemorrhoids to more serious conditions such as inflammatory bowel disease (IBD) or colorectal cancer. While your previous colonoscopy showed normal results, it is essential to consider that conditions can develop over time, and the recurrence of blood in the stool should not be ignored.

The symptoms you describe, including increased bowel sounds and the sensation of needing to have a bowel movement without producing stool, align with what is often seen in irritable bowel syndrome (IBS). IBS is a functional gastrointestinal disorder characterized by a combination of symptoms, including abdominal pain, bloating, and altered bowel habits. Stress and anxiety can exacerbate these symptoms, leading to a cycle of discomfort and further anxiety.

Given your history and current symptoms, it would be prudent to seek further evaluation. While your previous colonoscopy was normal, the recurrence of blood in your stool and changes in your bowel habits suggest that a follow-up examination may be necessary. A gastroenterologist can assess your symptoms in detail and may recommend additional tests, such as a repeat colonoscopy or imaging studies, to rule out any underlying conditions.

In addition to medical evaluation, consider lifestyle modifications that may help manage your symptoms. Dietary changes, such as increasing fiber intake, staying hydrated, and avoiding trigger foods, can improve bowel regularity. Regular physical activity is also beneficial for gastrointestinal health. Furthermore, managing stress through relaxation techniques, therapy, or medication may alleviate some of the symptoms associated with IBS.

In summary, while your previous colonoscopy was normal, the recurrence of blood in your stool and changes in bowel habits warrant further investigation. It is essential to communicate openly with your healthcare provider about your symptoms and concerns. Early detection and management of gastrointestinal issues can lead to better outcomes and improved quality of life. Don’t hesitate to seek help; your health is paramount.

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