Constipation: When to Seek Further Gastrointestinal Evaluation

Bowel movement issues?

Hello doctor, I have been experiencing long-term constipation.
In mid-April, I noticed that I couldn't fully empty my bowels.
I underwent a rectal examination, which was normal, and then I was referred for a barium enema, the results of which were also normal.
In mid-June, I noticed that my stools became thinner, about the size of my thumb, and I experienced 1 to 2 instances of slightly green stools.
Up to now, my stools are still thin.
Previously, I would have a bowel movement every two days, but now it's every 3 to 4 days, and I have to rely on enemas.
Why is this happening? Do I need to undergo a colonoscopy again?

Yang, 30~39 year old female. Ask Date: 2015/07/15

Dr. Chen Qifeng reply Gastroenterology and Hepatology

Hello, you have undergone a rectoscopy and a barium enema examination, which suggests colonic dysfunction.
It is recommended to reduce the intake of oily foods, dairy products, and irritants, while increasing the consumption of fruits, vegetables, and water.
If symptoms persist and bowel movements continue to be narrow, then a colonoscopy should be considered.
Sincerely, Dr.
Chi-Feng Chen, Attending Physician, Gastroenterology Department, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2015/07/15

More Info

Constipation is a common gastrointestinal issue that can significantly affect a person's quality of life. It is characterized by infrequent bowel movements, difficulty passing stools, or a sensation of incomplete evacuation. In your case, it seems that you have been experiencing persistent constipation for several months, with changes in the characteristics of your stool, such as a decrease in size and occasional green coloration.
Given your history of constipation and the recent findings from your rectal examination and barium enema, it is understandable that you are concerned about the changes in your bowel habits. The fact that your rectal exam and barium study returned normal results is reassuring, as these tests can help rule out structural abnormalities in the colon that could contribute to constipation. However, the persistence of your symptoms, particularly the change in stool size and the need for enemas to facilitate bowel movements, warrants further evaluation.

The change in stool size to that of a pencil or thumb can be indicative of several underlying issues. One possibility is that there may be a functional issue with the colon, such as slow transit constipation, where the movement of stool through the colon is delayed. Another possibility is that there could be a narrowing or obstruction in the colon, which could be caused by conditions such as strictures or even tumors, although the latter is less likely given your recent normal tests.

The green coloration of your stool can be attributed to several factors, including dietary changes, rapid transit through the intestines, or even the presence of bile. If food moves too quickly through the digestive tract, it may not have enough time to change color from green to brown, which is the typical color of stool due to the breakdown of bile.

In terms of next steps, it may be beneficial to consider a few additional evaluations. A colonoscopy could be a valuable tool in this situation, as it allows for direct visualization of the colon and the opportunity to take biopsies if necessary. This procedure can help identify any potential lesions, inflammation, or other abnormalities that may not have been detected by the previous tests.
Additionally, it may be worthwhile to assess your dietary habits and lifestyle factors that could be contributing to your constipation. Increasing fiber intake, staying well-hydrated, and engaging in regular physical activity can often help alleviate symptoms of constipation. If you have not already, consider discussing these lifestyle modifications with your healthcare provider.

If your symptoms persist despite these interventions, or if you experience any alarming symptoms such as significant weight loss, blood in your stool, or severe abdominal pain, it is crucial to seek further medical evaluation promptly. These could be signs of more serious underlying conditions that require immediate attention.

In summary, while your previous tests have returned normal results, the persistence of your symptoms and the changes in your bowel habits suggest that further evaluation may be warranted. A colonoscopy could provide valuable insights, and lifestyle modifications may also play a significant role in managing your constipation. Always consult with your healthcare provider for personalized advice and recommendations based on your specific situation.

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