Colonoscopy: When to Consider This Essential Procedure

Regarding colonoscopy?

Hello, Doctor.
About 4 to 5 years ago, I experienced persistent discomfort in my abdomen and consulted a physician.
The doctor, considering my age, only arranged for a sigmoidoscopy and did not perform a colonoscopy.
The diagnosis was irritable bowel syndrome.
However, recently my bowel movements have become irregular again, and I am experiencing abdominal discomfort.

I have a couple of questions:
1.
Since I had a sigmoidoscopy 4 to 5 years ago, should I be concerned about the possibility of malignant tumors in the rectum? I have heard that even if polyps are present, it takes many years for them to develop into tumors.
2.
I am currently 26 years old, and I always check for blood after bowel movements, but I understand that visual inspection may not be accurate.
If there is an issue with the colon, is it difficult to assess? Would you recommend that I undergo a colonoscopy?

Niming, 20~29 year old female. Ask Date: 2015/08/29

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Anonymous, your condition may indeed be Irritable Bowel Syndrome (IBS), but being young does not mean you should not be concerned about tumors.
A comprehensive evaluation is necessary.
If you are worried, the first step can be to arrange for a stool test.
If any issues arise, further examinations can be conducted.
If everything is fine, the chances of disease can be reduced.
Changhua Hospital cares about your health.

Reply Date: 2015/08/29

More Info

Colonoscopy is a vital procedure for diagnosing and managing various gastrointestinal conditions, particularly those affecting the colon. Given your history of gastrointestinal discomfort and the previous diagnosis of irritable bowel syndrome (IBS), it's understandable that you have concerns about your current symptoms and the necessity of undergoing a colonoscopy.

Addressing Your Concerns
1. Risk of Colorectal Cancer: You mentioned that you had a flexible sigmoidoscopy performed 4-5 years ago, which did not reveal any malignancies. While it is true that polyps can take several years to develop into cancer, it is essential to understand that this does not eliminate the risk entirely. The risk factors for colorectal cancer include age, family history, personal history of polyps, and certain genetic conditions. At 26 years old, your risk is generally lower, but symptoms such as persistent abdominal discomfort and changes in bowel habits warrant further investigation.

2. Symptoms and Their Implications: You noted that your bowel movements have become irregular again, and while you have not observed blood, it is crucial to recognize that some gastrointestinal issues can manifest without visible signs. Conditions such as inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, can present with abdominal pain, diarrhea, and other symptoms without overt bleeding. A colonoscopy can help visualize the entire colon and identify any abnormalities, including inflammation, ulcers, or polyps.

3. The Importance of Colonoscopy: Given your symptoms and the fact that you are experiencing changes in your bowel habits, a colonoscopy is advisable. This procedure allows for a comprehensive examination of the colon and rectum, enabling the physician to detect any potential issues that may not be evident through other examinations. Additionally, if any polyps are found during the procedure, they can often be removed on the spot and sent for biopsy to assess for precancerous changes.

4. When to Consider a Colonoscopy: The American College of Gastroenterology recommends that individuals with alarming symptoms—such as significant changes in bowel habits, unexplained weight loss, persistent abdominal pain, or family history of colorectal cancer—should undergo a colonoscopy. In your case, the combination of your age, previous gastrointestinal issues, and current symptoms makes a compelling case for this procedure.

Conclusion
In summary, while your previous sigmoidoscopy may have provided some reassurance, the emergence of new symptoms and your age suggest that a colonoscopy is a prudent next step. It is a safe and effective procedure that can provide valuable insights into your gastrointestinal health. Discussing your concerns with a gastroenterologist will help you understand the risks and benefits of the procedure, and they can guide you through the process, ensuring that you receive the appropriate care tailored to your needs.

If you have any further questions or concerns about the procedure, its preparation, or what to expect afterward, do not hesitate to reach out to your healthcare provider. They can provide you with the information and support you need to make an informed decision about your health.

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