15 April 2021
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Bowel actions: how important are they?

Dr Ross Walker
17 March 2021

It is often said that symptoms are your ticket into the medical system. One of the most common symptoms, especially as we age, are changes in our bowel habit in some form.

These symptoms can vary from changes in frequency and consistency to obvious diarrhoea, constipation, plus varying colour of our stools to obvious blood loss. Also, to bring up a somewhat unpleasant concept is the odour of our stools may also change.

The problem for a non-medical person is when this should be reported to your doctor? Firstly, and probably most importantly, is when you notice a significant change either way. If you are experiencing increasing constipation or the exact opposite i.e. increasing diarrhoea, this is a red flag and a prompt for you to discuss this with your doctor.

In many cases, it may be purely related to a dietary change or possibly some new medications or often even over-the-counter supplements or vitamins. One very good example is that many people are now using magnesium in some form, which in my experience, causes diarrhoea in around 10% of people who take one of these preparations.

More dramatic diarrhoea or constipation is always a sign that there is a more significant underlying problem that needs to be addressed. If this is present for any more than a week or two and doesn't appear to be settling, you need to make an appointment with your general practitioner immediately.

The causes can be anything from some type of bowel infection, irritable bowel syndrome to more serious inflammatory bowel diseases. There is always the ever-present reminder that we should be constantly aware of and be screened for bowel cancer.

There are numerous causes for both diarrhoea and constipation but this is not something where you should be seeking an over-the-counter preparation for either condition (of which there are many) until a firm diagnosis has been made (so to speak).

Another significant issue is that of any form of rectal bleeding. Very dark stools are typically related to bleeding in the upper part of the gut or possibly iron tablets taken for other reasons. Bright red bleeding when you open your bowels or wipe yourself is typically due to haemorrhoids but equally may be the first sign of a more serious condition. Black stools and significant bright red rectal bleeding should be considered medical emergencies and you should urgently seek medical help. Also, if you have had blood tests and you are found to be anaemic and/or low in iron (especially the ferritin level), your doctor should be hunting for a cause, not purely give you iron supplements. Also, it is important to realise that not all anaemia is due to low iron levels in the body.

The most important point I am trying to make here is that you shouldn’t ignore a change in your bowel habit in any way because the earlier a significant condition is detected, the greater the chance of treatment being effective and also potentially cured.

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