Few people enjoy talking about their bowels but this is an important topic. Embarrassment costs many lives every year due to colon cancer that is diagnosed when it is too advanced to respond to treatment.

 

Normal bowel habits

Before exploring what an altered bowel habit is, it is important to review what is 'normal'. There is actually no 'normal' number of times to visit the toilet and open your bowels, but you will know what is normal for you. Some people are very regular, opening their bowels at around the same time, one or more times every day. For others, a normal bowel habit may involve going just every three or four days.

Whatever your normal behaviour, an altered bowel habit is anything that differs from this, involving either a change in frequency of bowel movements, or a change in the consistency of the stool. Two common conditions are experienced by everyone at one time or another:

• Constipation: harder stools, combined with less frequent visits to the toilet.
• Diarrhoea: looser stools (sometimes almost like water), combined with a more frequent urge to open the bowels.
• If this is a short-term problem and can be traced to a probable cause (possible food poisoning, change in diet, gastric flu), it is probably nothing to worry about. Prolonged or recurring altered bowel habits may be a sign of a more serious condition, such as bowel cancer or inflammatory bowel disease, and you should seek medical advice.

 

Symptoms of constipation

If you are constipated, you may not feel the urge to go to the toilet as often, and when you do it may feel like a strain. Your stools will be drier and harder and may be either larger or significantly smaller than usual, and will be more difficult to pass. You may also feel like you have not fully emptied your bowels and you may feel sluggish and uncomfortable.

If it continues, constipation can leave you feeling bloated and nauseous, and can cause stomach aches and appetite loss. You may also experience an increased urge to pass gas to relieve the pressure in your abdomen.

 

Symptoms of diarrhoea

If you have diarrhoea, you will feel the need to go to the toilet much more frequently, often urgently, and you will pass looser stools than normal. Diarrhoea can range in severity from slightly softer stools to an entirely liquid discharge, and will normally last from two to four days in adults and up to a week in children. In most cases, diarrhoea is a side-effect of a stomach bug or mild food poisoning, and it will clear up on its own without treatment.

Although a few spots of bright red blood on the toilet paper are common when you are having to go to the toilet frequently, blood mixed with the stool always requires further investigation. When this occurs in association with diarrhoea it may indicate a significant infection in the colon, or inflammatory bowel disease.

 

When to seek medical help

Constipation

Normally constipation can be eased by drinking more fluids and eating foods rich in fibre. Short-term relief can be obtained with over-the-counter laxatives. In some cases it can take many weeks for normal bowel habits to return, especially if the cause of the constipation, such as diet or a lifestyle factor, is not addressed properly.

Diarrhoea

Short-term diarrhoea may need no specific treatment, but maintaining oral fluid intake is important to prevent dehydration.

If you have severe diarrhoea for more than 48 hours and are experiencing vomiting and symptoms of dehydration, it is best to consult your doctor. You may need admission to hospital and intravenous fluid replacement therapy.

Alternating constipation and diarrhoea

If you have alternating bouts of diarrhoea and constipation and your bowel habit doesn't seem to settle, it is best to get checked out. These symptoms can be a sign of an underlying bowel disease—including irritable bowel syndrome or an inflammatory bowel condition. The correct treatment may help ease the problem. If you notice any blood in your stools, especially when preceded or accompanied by a change in bowel habit, you should seek medical advice.

 

Investigating and treating a change in bowel habit

The Gastroenterology and Hepatology specialists at The Physicians' Clinic are extremely experienced in assessing, investigating, and treating patients with any of these problems.

A change in bowel habit is usually nothing serious, but it is important to be sure. The earlier a clear diagnosis is made, the better the chance of effective treatment or, as is often the case, getting reassurance. Investigations that may be suggested include blood tests, stool tests, scans, and colonoscopy. Colonoscopy (an examination of the lower bowel using a flexible telescope) is a safe and extremely accurate way of investigating a change in bowel habit.