Bowel Issues: When to Seek Further Evaluation

Bowel issues

Hello, doctor.
I would like to ask about my bowel movements.
I have a bowel movement every day, and the first stool is solid, but the subsequent stools are soft and appear fragmented (not diarrhea).
Is this normal? I have a combination of formed and loose stools.
After a bowel movement, I sometimes feel a heaviness in my abdomen and have the urge to defecate, but I am unable to do so.
Occasionally, I experience a dull pain on the right side of my abdomen.
I have had a fecal occult blood test that was negative.
For a period, I also felt a heaviness in my anal area and consulted a surgeon, who said I am still young and advised me to eat more fruits and vegetables, suggesting that a colonoscopy is not necessary.
Is that correct? A colleague of mine, who is only 36, was diagnosed with stage II colorectal cancer.
Can I opt for a colonoscopy at my own expense? Thank you.

Mifeng, 30~39 year old female. Ask Date: 2016/01/10

Dr. Ke Fangxu reply Surgery

Based on your description, it seems that the likelihood of irritable bowel syndrome (IBS) is higher.
It is recommended to start with a light diet and maintain a good daily routine.
If symptoms persist without improvement, you may consult a physician for medication.
If there is still no improvement or if you are very concerned, a colonoscopy can be arranged, as the risk of colorectal cancer is not zero at this age.
Therefore, health insurance can cover the cost of a colonoscopy.
(In my personal experience, the youngest case I have diagnosed was 25 years old.)

Reply Date: 2016/01/10

More Info

Understanding bowel issues can be quite complex, and it's important to differentiate between normal variations in bowel habits and symptoms that may indicate a more serious condition. Based on your description, it seems that you are experiencing a mix of formed and loose stools, along with some abdominal discomfort. Let's break down your concerns and provide some clarity on when to seek further evaluation.

Firstly, it's not uncommon for individuals to have variations in stool consistency. The fact that your first stool of the day is well-formed while subsequent stools are softer or scattered can be influenced by several factors, including diet, hydration, and gastrointestinal motility. A diet high in fiber, which includes fruits and vegetables, can lead to softer stools as fiber helps to bulk up stool and promote regular bowel movements. However, if you notice a significant change in your bowel habits, such as a persistent change in stool consistency or the presence of discomfort, it may warrant further investigation.

The sensation of having a full bowel but being unable to pass stool can be indicative of several conditions, including constipation, irritable bowel syndrome (IBS), or even more serious issues like bowel obstruction. The occasional right-sided abdominal pain you mentioned could also be related to these conditions, but it is essential to consider other potential causes as well.
Regarding your concern about colorectal cancer, it's understandable to be anxious, especially given your colleague's diagnosis at a relatively young age. While colorectal cancer is more common in older adults, it can occur in younger individuals as well. Risk factors include family history, certain genetic conditions, and lifestyle factors such as diet and physical activity. If you have any concerning symptoms—such as significant changes in bowel habits, unexplained weight loss, persistent abdominal pain, or blood in the stool—it's crucial to discuss these with your healthcare provider.

Your doctor’s recommendation to increase fiber intake and monitor your symptoms is a common initial approach for mild gastrointestinal complaints. However, if you continue to experience symptoms or if they worsen, you should feel empowered to seek further evaluation. A colonoscopy is a valuable diagnostic tool that can help identify any underlying issues, including polyps or signs of inflammation. If you are considering self-paying for a colonoscopy, it is advisable to discuss this with your healthcare provider to ensure it is appropriate based on your symptoms and medical history.

In summary, while occasional variations in stool consistency can be normal, persistent symptoms, especially those accompanied by discomfort, should not be ignored. It is always better to err on the side of caution when it comes to gastrointestinal health. If you feel that your symptoms are affecting your quality of life or if you have any concerns about colorectal cancer, do not hesitate to advocate for yourself and seek further evaluation. Your health is paramount, and being proactive is key to ensuring any potential issues are addressed early on.

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