CHANGES IN BOWEL HABITS

By Waleed Sheikh
 CHANGES IN BOWEL HABITS

Vary person to person (once or twice a day)

Changes:
• Frequency of defecation
• Stool colour
• Stool type
•
IRRITABLE BOWEL SYNDROME (IBS)
 IRRITABLE BOWEL SYNDROME (IBS)

• Chronic condition
• Very common estimated that the prevalence
in the UK is 17% overall, with a prevalence
of 11% among men and 23% among women
• 1 in 20 GP consultations
 IRRITABLE BOWEL SYNDROME (IBS)

Causes:
• Muscle contractions in the intestine
• Nervous system hypersensitivity
• Some people with IBS have an increased number of immune-system cells in
their intestines
• IBS can develop after a severe bout of diarrhoea (gastroenteritis) caused by
bacteria or a virus
• Changes in gut microflora
 IRRITABLE BOWEL SYNDROME (IBS)

Symptoms:
• Abdominal pain, cramping or bloating that is typically
relieved or partially relieved by passing a bowel movement
• Excess gas
• Diarrhoea or constipation — sometimes alternating bouts
of diarrhoea and constipation
• Mucus in the stool
 IRRITABLE BOWEL SYNDROME (IBS)

Diagnosis:
abdominal pain / discomfort relieved by defaecation or
associated with altered bowel frequency or stool form + 2/4
from:
• altered stool passage
• abdominal bloating distension, tension or hardness
• symptoms made worse by eating
• passage of mucus.
 IRRITABLE BOWEL SYNDROME (IBS)

Tests to exclude other diagnoses

• Full blood count (FBC)
• Erythrocyte sedimentation rate (ESR) or plasma viscosity
• C-reactive protein (CRP)
• Antibody testing for coeliac disease (endomysial antibodies
[EMA] or tissue transglutaminase [TTG])
 IRRITABLE BOWEL SYNDROME (IBS)

Treatment:
• Diet and lifestyle advice (if persistent then referral to
dietician)
• Antispasmodics (atropine)
• Laxatives
• Antimotility (loperamide)
• TCA (low dose)
• SSRI
 INFLAMMATORY BOWEL DISEASE (IBD)

Inflammation of any part of the GI tract but most

importantly the small intestine or ascending colon
• Heredity:You may inherit genes that make you more
susceptible to developing Crohn’s
• The immune system: When triggered, it affects the
gastrointestinal tract, causing inflammation that contributes
to symptoms
• Environmental factors: Bacteria, a virus, or some
unidentified factor in the environment that triggers an
abnormal immune response
INFLAMMATORY BOWEL DISEASE (IBD)

Crohns vs Ulcerative colitis

 INFLAMMATORY BOWEL DISEASE (IBD)

Symptoms :
• Abdominal pain • Weight loss
• Diarrhoea • Fever
• Nausea • Fatigue
• Vomiting
• Loss of appetite
 INFLAMMATORY BOWEL DISEASE (IBD)

Diagnosis:
• Stool culture
• Faecal calprotectin to differentiate between IBS and IBD
• Colonoscopy
• Barium enema
• CT / MRI
 INFLAMMATORY BOWEL DISEASE (IBD)

Crohns Treatment:
• Glucocorticosteroids
• Budesonide (if young or above not tolerated)
• Aminosalicylate (weakest)
• Surgery (if limited to distal ileum)
• Add on biologics
 INFLAMMATORY BOWEL DISEASE (IBD)

UC Treatment:
• Aminosalicylate (topical is first line then oral can be added
on)
• corticosteroids
• Biologics and Janus Kinase inhibitors
• Surgery to remove colon
 IBS VS IBD

• Constipation + diarrhoea • Diarrhoea only

• Obvious triggers • No obvious triggers
• No pathological signs in • Pathological signs of
colonoscopy inflammation in
• Mucus in stool colonoscopy

• Not an actual disease only • Blood in stool

functional issues • Associated anaemia, joint
pain, eye inflammation and
weight loss
BOWEL CANCER
 BOWEL CANCER

RED FLAGS
• unintentional and unexplained weight loss
• rectal bleeding
• family history of bowel or ovarian cancer
• change in bowel habit to looser and/or more
frequent stools persisting for more than 6 weeks
in a person aged over 60 years.
 BOWEL CANCER

Diagnosis:
• Colonoscopy
• Biopsy
• Bloods for carcinoembryonic antigen (CEA)
• Contrast CT
• MRI
 BOWEL CANCER

Treatment:
• Excision
• Stenting
• Chemo if metastatic