Patient Information

Change in Bowel Habit

Understanding what a change in bowel habit means, when to seek assessment, and how symptoms are investigated.

What does "change in bowel habit" mean?

A change in bowel habit means a persistent change from what is normal for you. Many causes are harmless and common, but persistent symptoms should always be assessed properly to exclude more serious conditions.

Symptoms that may indicate a change in bowel habit

—Opening your bowels more often or less often

—Loose stools or diarrhoea

—Hard stools or constipation

—Alternating diarrhoea and constipation

—Increased urgency

—Feeling that you do not empty properly

—Passing mucus

—New bloating or abdominal discomfort

Common Causes

·Irritable bowel syndrome (IBS)

·Dietary changes

·Stress or anxiety

·Constipation

·Diverticular disease

·Haemorrhoids

·Infection

·Medication side effects

·Inflammatory bowel disease (Crohn's or ulcerative colitis)

·Bowel polyps

·Bowel cancer

Symptoms Requiring Prompt Assessment

National guidelines (NG12) recommend urgent investigation for symptoms that may suggest bowel cancer. Please seek medical review promptly if you experience:

·Rectal bleeding, particularly if persistent

·A persistent change in bowel habit lasting more than 6 weeks

·Unexplained iron deficiency anaemia

·Unexplained weight loss

·Persistent abdominal pain

·A lump in the abdomen or rectum

·Extreme tiredness or fatigue

·New symptoms in patients over 50 years of age

·A strong family history of bowel cancer or polyps

Most people with these symptoms do not have cancer, but investigation is important to exclude serious disease.

How Are These Symptoms Investigated?

Blood Tests

·Full blood count (to look for anaemia)

·Iron levels

·Inflammatory markers

·Coeliac testing

FIT Test (Faecal Immunochemical Test)

This stool test detects tiny amounts of blood that may not be visible to the eye. FIT testing is widely used to help identify patients who may require further investigation of the bowel.

Colonoscopy

A thin flexible camera passed through the back passage to inspect the large bowel directly. Regarded as the best test for examining the bowel.

Advantages

·Most accurate test for the bowel lining

·Allows biopsies and removal of polyps

·Can diagnose inflammation, polyps and cancer

Disadvantages

·Requires bowel preparation

·Usually involves sedation

·Small risks of bleeding or bowel perforation

CT Colonography

"Virtual Colonoscopy"

Uses a CT scanner to produce detailed images of the bowel after gentle inflation with gas.

Advantages

·Less invasive than colonoscopy

·Usually no sedation required

·Good at detecting larger polyps and cancers

Disadvantages

·Polyps cannot be removed during the scan

·Biopsies cannot be taken

·Colonoscopy still required if abnormalities found

CT Scan with Oral Contrast

Particularly useful when symptoms include abdominal pain, weight loss, suspected inflammation, or possible diverticular disease.

Advantages

·Good overview of the abdomen and pelvis

·Useful for identifying inflammation or masses outside the bowel

Disadvantages

·Does not examine the bowel lining in as much detail as colonoscopy

·Small polyps can be missed

·Biopsies and polyp removal are not possible

What Happens if Polyps Are Found?

Polyps are small growths in the bowel lining. Most are benign, but some can slowly develop into cancer over many years. Polyps found during colonoscopy are usually removed and sent for analysis. Some patients require follow-up surveillance colonoscopy depending on the type, size, and number of polyps identified.

When Should I Seek Urgent Help?

—Heavy rectal bleeding

—Severe abdominal pain

—Persistent vomiting

—Inability to open your bowels or pass wind

—Black stools

—Rapid unexplained weight loss

Important Reassurance

Most changes in bowel habit are caused by benign conditions and not bowel cancer. However, persistent or unexplained symptoms should always be assessed carefully to ensure serious conditions are not missed. Early investigation and diagnosis are important and are often reassuring.

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