Bowel Issues: From Constipation to Diarrhea Concerns

Bowel movement issues

Hello Doctor: I have had constipation since childhood, with bowel movements occurring every 3 to 5 days, often accompanied by blood.
About three years ago, I developed a routine of daily bowel movements, and I no longer saw blood.
However, around September of last year, I suddenly experienced diarrhea for a week.
Since then, until now in February, my bowel habits have changed; I no longer have daily bowel movements and now go about every three days.
I researched the symptoms of colorectal cancer, and one of them is a change in bowel habits—could this be what I'm experiencing? Additionally, I had one or two instances of passing thinner, elongated stools, but since then, my stools have mostly been loose.
Sometimes they are soft and tubular, while other times, only part of the stool comes out in a tubular shape, and the rest is very loose.
It feels like there is a digestive issue, as the latter part cannot form into a tubular shape.
After wiping, there is a somewhat watery, muddy residue (similar to the mucus seen with diarrhea), and occasionally there is a bit of blood.
My flatulence has a noticeably foul odor.
I previously consulted a gastroenterologist, who said that at my age, the likelihood of developing colorectal cancer is extremely low, and advised me not to worry.
Even if I were to undergo testing, it would only be for peace of mind, so I did not proceed with any tests.
After the diarrhea episode, I temporarily stopped working, and I'm unsure if work-related stress could be affecting my bowel habits or if there might be other possible underlying conditions.
(Additionally, my grandfather was recently diagnosed with colorectal cancer...) I would appreciate your insights on this matter.
Thank you.

Chen, 20~29 year old female. Ask Date: 2016/02/04

Dr. Yang Zhichao reply Gastroenterology and Hepatology

Dear Mr.
Chen, based on your symptoms and family history, we cannot completely rule out the possibility of cancer.
However, given your young age, the likelihood of cancer is low.
If you are concerned, I recommend scheduling a colonoscopy.
Additionally, due to your family history, it would be advisable for you to have a colonoscopy every 1-2 years after the age of 40.
Thank you for your inquiry.

Reply Date: 2016/02/04

More Info

Understanding bowel issues, especially when they involve changes in bowel habits, can be concerning. Your symptoms, including a history of constipation, recent diarrhea, and changes in stool consistency, warrant careful consideration. Let's break down your concerns and provide some insights based on medical knowledge.

1. Changes in Bowel Habits: You mentioned that you had a history of constipation, which then transitioned to more regular bowel movements, and now you are experiencing a return to infrequent bowel movements (every three days) along with diarrhea. Changes in bowel habits can be indicative of various gastrointestinal conditions, including Irritable Bowel Syndrome (IBS), inflammatory bowel diseases (like ulcerative colitis or Crohn's disease), or even colorectal cancer, although the latter is less likely given your age and the reassurance from your gastroenterologist.

2. Stool Characteristics: The presence of thin, ribbon-like stools can be alarming, as it is often associated with potential obstructions or strictures in the colon. However, it is essential to note that temporary changes in stool shape can occur due to dietary factors or transient gastrointestinal disturbances. The mucus-like consistency and occasional blood in your stool are also symptoms that should not be ignored. Mucus can be produced in response to inflammation or irritation in the intestines.

3. Diarrhea and Its Causes: The diarrhea you experienced for a week last September could have been due to an acute gastrointestinal infection, food intolerance, or stress-related changes in bowel function. Stress can significantly impact gut health, leading to conditions like IBS, which is characterized by alternating patterns of diarrhea and constipation. It is also possible that your recent stressors, including your family history of colorectal cancer, may be contributing to your gastrointestinal symptoms.

4. Concerns About Colorectal Cancer: While your gastroenterologist has reassured you that the likelihood of colorectal cancer at your age is low, it is understandable to be concerned, especially with a family history of the disease. The symptoms you describe—changes in bowel habits, mucus in the stool, and occasional blood—should be monitored closely. If these symptoms persist or worsen, it would be prudent to seek further evaluation, potentially including a colonoscopy, to rule out any serious conditions.

5. Management and Next Steps: Given your symptoms, it is essential to maintain a healthy diet rich in fiber, stay hydrated, and manage stress effectively. Regular physical activity can also help regulate bowel function. If your symptoms persist, consider revisiting your gastroenterologist for a more thorough evaluation, including stool tests and possibly imaging studies. Keeping a symptom diary can also be helpful in identifying triggers related to your diet or stress levels.

In summary, while your symptoms may not necessarily indicate a severe underlying condition, they warrant further investigation, especially given your family history. It is crucial to communicate openly with your healthcare provider about your concerns and symptoms. Regular follow-ups and appropriate screenings can help ensure that any potential issues are addressed promptly. Remember, proactive management of your gastrointestinal health is key to maintaining overall well-being.

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