What should I do about my trouble having bowel movements given my family history of colon cancer?

Immediate Colonoscopy Referral Required

Given your constipation symptoms combined with a family history of colon cancer, you need to see a gastroenterologist urgently for a colonoscopy—do not delay this appointment, and if you haven't scheduled it yet, call immediately to book it. 1, 2

Why This Is Urgent

Your situation involves two critical red flags that require immediate evaluation:

• Constipation (change in bowel habits) is a high-risk symptom that warrants diagnostic colonoscopy rather than stool testing, especially with your family history 1
• Your mother's colon cancer diagnosis places you at 1.7-3 times higher risk than someone without family history, and this risk is even higher if she was diagnosed before age 60 2, 1
• Colonoscopy should be performed within 30 days when patients present with alarming symptoms like bowel habit changes, particularly in the context of family history 1

What You Should Do Right Now

Contact the gastroenterology office immediately to schedule your colonoscopy if you haven't already:

• If you received a referral letter but haven't called yet, make that call today 1
• Explain both your constipation symptoms AND your mother's colon cancer history when scheduling 2
• Request the earliest available appointment, emphasizing this is not routine screening but evaluation of symptoms with family history 1

Your Screening Timeline Based on Family History

When you should have started screening (even without symptoms):

• If your mother was diagnosed before age 60: You should begin colonoscopy at age 40 OR 10 years younger than her age at diagnosis, whichever comes first 2, 3
• If your mother was diagnosed at age 60 or older: You should begin colonoscopy at age 50 1, 2
• Screening intervals: Every 5 years (not the standard 10 years for average-risk individuals) 2, 3

Why Stool Tests Are Not Appropriate for You

Do not use fecal immunochemical testing (FIT) or other stool tests in your situation:

• FIT is not recommended for symptomatic patients because it delays diagnosis and can miss cancers 1
• With constipation as a symptom, you need direct visualization of your colon, not indirect testing 1
• Delays in obtaining colonoscopy are associated with more advanced-stage disease at diagnosis 1

Temporary Symptom Management While Awaiting Colonoscopy

While waiting for your appointment, you can use over-the-counter fiber supplements for constipation relief:

• Psyllium or methylcellulose can help with constipation, generally producing bowel movement in 12-72 hours 4, 5
• However, stop use and seek immediate medical attention if: constipation lasts more than 7 days, you develop rectal bleeding, or you fail to have a bowel movement—these may indicate serious conditions 4, 5
• Take with adequate fluid to prevent choking 5

Additional Important Considerations

Information to provide your gastroenterologist:

• Your mother's exact age at colon cancer diagnosis 2
• Whether any other family members (siblings, grandparents, aunts, uncles) have had colon cancer or polyps 1, 2
• Complete details about your constipation: duration, severity, associated symptoms (weight loss, blood in stool, abdominal pain) 1

Genetic testing may be recommended: Up to 13% of colon cancers, especially those diagnosed at younger ages, are associated with hereditary syndromes like Lynch syndrome, and all patients with early-onset colon cancer should undergo genetic testing 1, 2

Common Pitfalls to Avoid

• Do not accept reassurance without colonoscopy when you have both symptoms and family history 1
• Do not delay scheduling because symptoms seem mild—early detection dramatically improves outcomes 1
• Do not assume your risk is average just because only one family member was affected—even one first-degree relative significantly increases your risk 2, 1