CHANGE IN BOWEL HABIT
There is no absolute normal standard for frequency or consistency of bowel action. We've all experienced "tummy upsets" caused by viral infections or dietary changes - as on holiday. Some of us may have had actual food poisoning which can leave the bowels affected for some time afterwards. Those of us who have needed strong codeine based painkillers may have experienced constipation when the passage of stool is infrequent and the stool itself hard and difficult to pass.
When does bowel habit become abnormal and require attention?
The first thing to establish is what is normal for you. Most of the population have a bowel action between three times a day and once every three days but knowing this is less important than comparing what your frequency is currently with what it was a few months ago or a couple of years ago. Gradual change is more likely to pass unnoticed than sudden change and if unrelated to obvious causes such as a change in dietary habits or the introduction of new or different medication is also more likely to be significant in the long run - sudden change is more likely to be due to infection or some obvious external factor. Other relevant factors are general health including weight loss or gain especially. Passage of blood may well be significant though a bulky hard stool can often cause a little fresh blood loss by trauma to the anal canal in which case there will be obvious soreness. This will need checking if it recurs repeatedly and especially in patients over 45 years of age.
Change which persists beyond two weeks should be checked unless there was a very obvious cause such as a bout of food poisoning (remember: food handlers, health workers and those who work with the elderly or with babies should get a stool specimen checked and be given the "all clear" before returning to work following a bout of diarrhoea, even if the stool is normal). Patients over 45 should be checked out after two weeks change in bowel habit anyway. Patients with diarrhoea can assist the doctor by sending a stool specimen to the laboratory before your appointment with the doctor (enquire at reception for the appropriate sample pot). However, you should not wait for the result before making the appointment and should not cancel the appointment unless your bowel habit returns to normal by itself.
Medication is a common cause for bowel habit change. Codeine-type painkillers, iron, antidepressants, anti-Parkinson drugs and drugs for urinary incontinence can all cause constipation though sometimes strangely some can cause diarrhoea. Laxatives, especially if used inappropriately, can cause diarrhoea as can some other drugs which speed up intestinal action such as anti-sickness drugs. If prescribed medication could be the cause please discuss it with your doctor. Over the counter medication should be stopped to see what happens. (Paracetamol should have little affect on bowel habit if a painkiller is needed). Information on drugs is available at Virtual Health Network who also provide authoritative information to the profession.