Check your symptoms

A "change in bowel habits" refers to any alteration in how often you have bowel movements, the ease with which you pass stool, or changes in the stool's appearance. Such changes are common and usually not cause for concern. They can be triggered by factors like dietary adjustments, stress, reactions to recent infections, new medications, changes in physical activity, or even aging. If these changes are temporary and your bowel habits return to normal, they are typically considered normal.

However, a persistent or progressively worsening change in bowel habits could indicate something more serious. If this is accompanied by bowel bleeding, weight loss, or continuous, localized abdominal pain, it’s important to consult a doctor promptly. A shift towards looser or more frequent stools is generally considered more concerning than constipation.

Bleeding from the bowel, when it is red in colour or clots is usually from haemorrhoids (‘piles’), which are large veins in and around the anus. Bleeding from haemorrhoids is typically seen on the toilet paper or even dripping into the toilet, can appear quite dramatic, and will occur at one motion or several consecutive motions but then stops. If this bleeding is very infrequent then it should be of little concern.

Bleeding with significant pain on passing a stool usually indicates an anal fissure, a split in the lining of the anus usually caused by passing a very hard stool that should heal over days to a few weeks.

Bleeding that is present all or most of the time or is clearly mixed into the stool needs checking out as this may represent a large polyp or even cancer. Bleeding of blood that is much darker or even black and foul-smelling indicates blood from higher up and this needs to be checked by your doctor.

This sensation suggests irritation of the rectum, which could indicate the presence of a large polyp or rectal cancer. If this feeling is persistent, it’s important to see your doctor for a thorough evaluation.

Weight loss can result from various factors, but if it occurs alongside a change in bowel habits or bowel bleeding, it could be a sign of bowel cancer, and you should consult your doctor promptly. The urgency increases if anemia is also present.

Anemia is characterized by a lower-than-normal level of red blood cells and is diagnosed through a blood test. There are many causes of anemia, with iron deficiency being a common one.

A slowly bleeding bowel polyp or cancer can lead to a gradual loss of red blood cells, along with the iron they contain, eventually resulting in anemia. This may cause symptoms like tiredness, weakness, or sometimes breathlessness.

Iron deficiency anemia is common in women before menopause. However, in men of any age and in both men and women after the age of 50, it might indicate slow bleeding from the bowel and should be investigated with a colonoscopy and/or gastroscopy. For premenopausal women, if anemia is recurrent or associated with bowel symptoms or weight loss, further investigation is likely warranted.

Gaseous bloating of the abdomen that fluctuates from day to day or throughout the day is typically caused by only a few factors. 

Constipation is an important factor to consider, and if it’s an issue, it should be addressed by increasing your intake of vegetables and fruits. You might also consider supplementing with Lactobacilli and Bifidobacteria, which can be found in fermented foods like sauerkraut, kimchi, Yakult yogurt, kefir, and kombucha, or in probiotic tablets. Additionally, the use of laxative teas or tablets can help alleviate constipation.

In some individuals, disordered breathing patterns can lead to air swallowing (aerophagia), often accompanied by persistent belching. This condition is commonly triggered by stress or anxiety. Exercises guided by a physiotherapist or speech-language therapist are typically effective in resolving it.

Bloating accompanied by increased passing of wind (flatus) is generally caused by a combination of factors, including bacterial fermentation of food in the colon, altered muscle tone in the diaphragm and abdominal muscles, and sometimes changes in how gas moves through the bowel. The best initial approach to managing these symptoms is a combination of daily gentle aerobic exercise and dietary adjustments.

Bacterial fermentation in the colon, which produces gas, is often stimulated by consuming foods high in sugars and sugar-like molecules known as FODMAPs. This is often associated with looser bowel movements. Foods that are particularly high in FODMAPs include apples, pears, large amounts of other fruit (more than a handful), members of the onion family (such as onions, garlic, spring onions, shallots, and leeks), honey, wheat, fructose, and artificial sweeteners like sorbitol, xylitol, and mannitol (commonly found in sugar-free gums and mints). Reducing the intake of these foods can significantly alleviate bloating symptoms.

Recent research has shown that restricting carbohydrates in general, similar to the Keto Diet, can be as effective as limiting FODMAPs for reducing bloating. This may be a useful alternative for many people. However, it is important to note that a strict Keto Diet, if followed continuously, can accelerate aging in your organs. To mitigate this risk, it is advisable to incorporate carbohydrates, such as rice or potatoes, into your diet two to three days a week.

In rare cases, especially in women, persistent abdominal bloating—particularly if it is of new onset—might be a sign of ovarian disease. In such cases, it is advisable to consult your GP about the possibility of an ultrasound of the pelvis.

A dietitian can also provide valuable guidance and support in managing these symptoms.

Loose motions are a common experience, often triggered by an infection, dietary indiscretions, or overconsumption of fruit. In most cases, bowel movements return to normal within a few days, and persistent loose motions are uncommon. However, conditions like Irritable Bowel Syndrome (IBS) can cause frequent episodes, though typically not constant. If you experience loose motions consistently or most of the time, it is important to consult your GP, as this could indicate an underlying issue that requires further investigation.

Broadly speaking, if you have a positive faecal immunochemical test (FIT test) there is a one third chance there is nothing much to be found, a one third chance that there is a medium-sized polyp or two, and a one third chance that there is a large polyp or cancer.  Overall a positive test means there is a 10% chance of cancer.  Amongst the cancers, some will be polyp cancers which means they might be curable by removal at colonoscopy by an Advanced Endoscopist rather than requiring surgery.

Because a positive bowel screening test has around a one third chance of having large polyps on colonoscopy, this is a situation where the colonoscopy should be ideally performed by an Advanced Endoscopist as this will maximise your chances of having the polyp dealt with at a single colonoscopy, and also if a polyp cancer is present, will maximise the chances of a curative resection that prevents the need for surgery.  

Occasionally, after an infection or after consuming something that disagrees with us, a sensation may develop in the upper esophagus, near the notch at the base of the neck and the top of the breastbone. This sensation might feel like something is stuck or like there is constant irritation in that area. While it may feel more pronounced when swallowing food, it does not obstruct swallowing, so there is no choking or vomiting involved.

This condition is known as 'globus' and is caused by sensitive nerves in the upper esophagus. It's not a disease, and these symptoms typically wax and wane over time before eventually disappearing. A gastroscopy is only necessary if there is actual difficulty swallowing.

Oesophageal dysphagia refers to food getting stuck somewhere between the throat and the stomach. This condition can cause discomfort, choking, and regurgitation of food or saliva, and it is never normal.

If oesophageal dysphagia is of recent onset and occurs with every meal, it is a serious symptom that requires urgent gastroscopy.

While occasional and infrequent episodes of oesophageal dysphagia may be associated with benign conditions such as gastroesophageal reflux, it is still recommended that most cases be investigated with a gastroscopy to rule out more serious issues.

Dyspepsia is characterized by a burning discomfort in the epigastrium, the area of the abdomen just below the breastbone. It is often accompanied by a sensation of fullness after eating small amounts or a prolonged feeling of heaviness after meals.

The severity of symptoms typically fluctuates and should not progressively worsen.

Dyspepsia is usually caused by an overly sensitive stomach and some degree of abnormal stomach motility. To manage symptoms, it's advisable to avoid alcohol and excessively fatty foods when symptoms are pronounced and to opt for smaller meals until improvement is noticed. If you have gained weight in recent years, losing weight may also help alleviate symptoms.

However, if the condition continues to worsen without improvement, or if it is associated with unintended weight loss, anemia, difficulty swallowing, or persistent vomiting, a gastroscopy is recommended to rule out more serious underlying causes.

Gastroesophageal reflux is common after meals, but in some people, it can become excessive and lead to Gastroesophageal Reflux Disease (GORD). Symptoms of GORD include heartburn, chest pain similar to angina, regurgitation of acid or food into the mouth, and sometimes a chronic dry cough. The likelihood of GORD increases with weight gain and the development of a hiatal hernia.

Managing GORD:
GORD often improves with simple lifestyle changes. Here are some tips:

• Avoid alcohol, coffee, and large meals, especially in the evening.

• Elevate the head of your bed if symptoms worsen at night.

• Over-the-counter antacids like Gaviscon or Mylanta can help.

• If symptoms persist, a short course of acid-suppressing medications like ranitidine, omeprazole, or pantoprazole may be needed. However, long-term use of these medications is no longer recommended—limit to short courses once symptoms are controlled.

• Some people find that a low-sugar diet helps manage symptoms.

When to Seek Medical Advice:
Intermittent heartburn is usually harmless and doesn't require investigation. However, a gastroscopy is recommended if:

• You have difficulty swallowing food.

• Caucasian males over 50 experience frequent heartburn, as they are at higher risk for Barrett's esophagus and dysplasia.

For severe GORD, where food or stomach fluid frequently refluxes into the mouth, surgery called fundoplication might be an option. Before considering surgery, a gastroscopy is performed, and a Gastroenterologist can refer you to a specialist Upper Gastrointestinal Surgeon.