From the Guidelines
Red flag bowel changes that require immediate medical attention include persistent blood in stool, severe or persistent abdominal pain, unexplained weight loss, and changes in bowel habits lasting more than two weeks, as these could indicate serious conditions such as colorectal cancer, inflammatory bowel disease, or gastrointestinal bleeding. According to the guidelines for the investigation of chronic diarrhoea in adults by the British Society of Gastroenterology 1, the presence of alarm features such as unexplained change in bowel habit, persistent blood in the stool, and unintentional weight loss should prompt referral for further investigations.
Some key red flags to watch out for include:
- Persistent blood in stool (either bright red or dark/tarry)
- Severe or persistent abdominal pain
- Unexplained weight loss
- Changes in bowel habits lasting more than two weeks
- Narrow or pencil-thin stools
- Nighttime bowel movements that wake you from sleep Other concerning changes include mucus in stool, persistent diarrhea or constipation unresponsive to over-the-counter remedies, and bowel changes accompanied by fever or vomiting, as noted in the american gastroenterological association medical position statement: irritable bowel syndrome 1.
While occasional changes in bowel habits can result from dietary changes, stress, or minor infections, persistent or severe symptoms should never be ignored, as the digestive tract is highly sensitive to changes in health status, and abnormal bowel movements often serve as early warning signs of underlying health issues, and prompt evaluation allows for earlier diagnosis and treatment, which significantly improves outcomes for many gastrointestinal conditions, as highlighted in the guidelines for the investigation of chronic diarrhoea in adults: british society of gastroenterology, 3rd edition 1.
From the FDA Drug Label
Gastrointestinal Disorders: abdominal distention, colitis, diarrhea, flatulence, nausea, pancreatitis, rectal polyp, vomiting The red flags for bowel changes associated with mesalamine include:
- Abdominal distention
- Colitis
- Diarrhea
- Pancreatitis
- Rectal polyp
- Vomiting 2
From the Research
Red Flags for Bowel Changes
Red flags for bowel changes are symptoms that may indicate a serious underlying condition, such as colorectal cancer. The following are some common red flags:
- Rectal bleeding: This is a common symptom of colorectal cancer, and it is essential to investigate its cause 3, 4.
- Changes in bowel habits: This can include constipation, diarrhea, or a change in the consistency of stool. While this symptom can be caused by various conditions, it is also a common symptom of colorectal cancer 5, 4.
- Abdominal pain: This can be a symptom of various conditions, including colorectal cancer. However, it is essential to note that abdominal pain is a non-specific symptom and can be caused by many other conditions 5, 6.
- Weight loss: Unexplained weight loss can be a symptom of colorectal cancer, especially if it is accompanied by other symptoms such as changes in bowel habits or rectal bleeding 7, 4.
- Anemia: This can be a symptom of colorectal cancer, especially if it is caused by chronic blood loss in the stool 6.
Diagnostic Yield of Colonoscopy
The diagnostic yield of colonoscopy for bowel changes depends on the symptom and the patient's age. For example:
- Rectal bleeding has a high diagnostic yield for colorectal cancer, especially in patients over 40 years old 3.
- Changes in bowel habits have a lower diagnostic yield for colorectal cancer, especially in patients under 50 years old 3, 6.
- Abdominal pain has a low diagnostic yield for colorectal cancer, especially in patients under 50 years old 6.
Influence of Symptoms on Timely Diagnosis
The symptoms of colorectal cancer can influence the timely diagnosis of the condition. For example:
- Rectal bleeding and changes in bowel habits are common symptoms of colorectal cancer, and patients with these symptoms are more likely to seek medical attention promptly 4.
- Abdominal pain is a non-specific symptom, and patients with this symptom may be less likely to seek medical attention promptly, which can delay the diagnosis of colorectal cancer 4.