Changes in Stool: When to Seek Medical Advice

Changes in stool consistency to a thinner shape and variations in color?

Hello, doctor.
I remember that my bowel habits used to be once every 1 to 2 days in the evening.
However, about two months ago, one night after dinner, I started experiencing diarrhea, which continued for several days.
Almost every time I eat, I have diarrhea.
I felt something was wrong and researched online, discovering that it could be colon cancer.
Since then, my bathroom habits have become irregular; sometimes I experience constipation, and other times diarrhea.
The appearance of my stool varies; sometimes it looks normal, and other times it appears thin.
Recently, I've been having bowel movements every 2 to 3 days, and sometimes I go 2 to 3 times in one day, usually around noon and in the evening, or in the morning and evening.
The intervals are relatively long, but I have to strain to pass stool, which is often thin.
Sometimes the stool starts off normal but then becomes soft and thin.
The color may vary due to my recent increased intake of fruits and vegetables; sometimes it appears green, sometimes normal, and at times it looks black or dark brown.
I also wonder if my anxiety or nervousness is causing my anal sphincter to tense up, making it harder to pass stool.
Aside from the irregularity and thin appearance of my stool, everything else seems normal; I have no abdominal pain, no blood, and my weight has not decreased.
I would like to ask the doctor if I need to undergo a colonoscopy, or if this is just a common case of irritable bowel syndrome.
Thank you.

Niming, 20~29 year old female. Ask Date: 2015/11/11

Dr. Ke Fangxu reply Surgery

Based on your description, the likelihood of irritable bowel syndrome (IBS) seems to be higher.
It is generally recommended to initially use medication to control symptoms during severe episodes, and then to maintain symptom relief through improvements in dietary habits and lifestyle.
It is advisable to reduce spicy and irritating foods and to establish a regular sleep schedule.
If symptoms persist, consider undergoing a colonoscopy.

Reply Date: 2015/11/11

More Info

When it comes to changes in bowel habits, especially when accompanied by symptoms such as diarrhea, constipation, or changes in stool appearance, it is important to take these changes seriously. Your description of fluctuating bowel habits, including episodes of diarrhea following meals, alternating constipation, and variations in stool appearance (such as thin or narrow stools, and changes in color) can be concerning. While some of these symptoms may be attributed to conditions like irritable bowel syndrome (IBS), they can also indicate more serious issues, including colorectal cancer.

Understanding Your Symptoms
1. Changes in Frequency and Consistency: The fact that you have experienced a significant change in your bowel habits over the past two months is noteworthy. Normal bowel habits can vary widely, but a sudden change, especially if it persists, warrants further investigation.

2. Stool Appearance: The description of your stools being sometimes thin or narrow can be particularly concerning. Narrow stools can sometimes indicate a blockage or narrowing of the colon, which can be caused by various factors, including polyps or tumors.

3. Color Changes: The color of your stool can be influenced by your diet, but persistent changes, especially to black or dark brown, should be evaluated. Black stools can indicate bleeding in the upper gastrointestinal tract, while green stools may be related to dietary factors or rapid transit through the intestines.

4. Associated Symptoms: While you mentioned that you do not have abdominal pain, blood in your stool, or weight loss, the presence of anxiety and difficulty relaxing during bowel movements can exacerbate gastrointestinal symptoms. Stress and anxiety can lead to or worsen conditions like IBS, which can cause alternating diarrhea and constipation.

When to Seek Medical Advice
Given your symptoms, it is advisable to consult a healthcare provider for a thorough evaluation. Here are some reasons why you should consider seeking medical advice:
- Duration of Symptoms: Symptoms that persist for more than a few weeks, especially changes in bowel habits, should be evaluated by a healthcare professional.

- Age and Risk Factors: If you are over the age of 50 or have a family history of colorectal cancer, it is particularly important to discuss your symptoms with a doctor.

- Diagnostic Tests: A colonoscopy is a common procedure used to examine the colon and rectum for abnormalities. Given your symptoms, your doctor may recommend this test to rule out any serious conditions, including colorectal cancer or inflammatory bowel disease.

- Other Investigations: Depending on your symptoms, your doctor may also suggest other tests, such as blood tests or imaging studies, to assess your overall health and rule out other potential causes of your symptoms.

Conclusion
While it is possible that your symptoms are related to a functional gastrointestinal disorder like IBS, the changes you have described warrant a medical evaluation to rule out more serious conditions. It is better to err on the side of caution when it comes to gastrointestinal symptoms, especially those that involve changes in bowel habits, stool appearance, and associated anxiety. Consulting with a healthcare provider will help you receive appropriate guidance and treatment, ensuring that any potential issues are addressed promptly.

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