Change in Bowel Habit

What constitutes a change in bowel habit?

A change in bowel habit means any alteration in an individual’s stool frequency, calibre or consistency. Virtually everyone will experience changes in their bowel habits at some point in their life as it may manifest due to stress or a change in the environment. However, it may also be a sign of a more serious underlying condition and warrants further investigation should it be persistent.

What causes a change in bowel habit?

Possible causes of a change in bowel habit include:

• Dietary intake: for example, excessive or inadequate fibre intake, intake of milk products, inadequate fluid intake
  
• Lack of exercise or physical activity
  
• Changes in lifestyle: for example, pregnancy, travel, change of job
  
• Medications: for example, painkillers, cough medications, antibiotics
• Infection: for example, gastroenteritis
• Neurological problems: for example, stroke, diabetes, parkinson’s disease
• Colorectal diseases: for example, colorectal cancer, inflammatory bowel disease
• Previous surgery: for example, previous colon resection, removal of gallbladder
• Irritable bowel syndrome
  

What tests do I need to undergo?

Changes in bowel habit that are due to dietary or lifestyle changes generally do not require further testing. However, in patients with associated ‘alarm signs’, we will perform further investigations. These are patients with:

• associated rectal bleeding or mucoid stools
• abdominal pain or swelling
• loss of weight and/or appetite
• family history of colorectal cancer or polyps

These patients should undergo evaluation of the colon in the form of an optical colonoscopy, CT colonography or barium enema. Individuals above the age of 50 years are also advised to undergo a colonoscopy for screening for colorectal cancer. In addition, patients with diarrhoea from suspected infection or antibiotic use may also benefit from special tests on their stools.

When colonic evaluation is normal and yet patients remain symptomatic, further tests for suspected functional bowel disorders may be performed. These tests include:

• anorectal manometry: to assess anal muscle tone
• transit marker studies: time taken for stools to empty
• defecography: to assess completeness of stool emptying
  

How to treat the change in bowel habit?

Treatment for changes in bowel habit depends on the cause and the severity of the condition, and often needs to be tailored to the individual’s needs. It may be treated with any combination of dietary and lifestyle modifications, medications such as laxatives, antidiarrhoeal medications or steroids for patients with inflammatory bowel disease. Treatments may also include bio-feedback exercises for patients with functional bowel disorders or even surgery. Surgery is necessary for patients who are diagnosed with existing medical conditions such as colorectal cancer, rectal prolapse or in recalcitrant slow transit constipation.