When to see a doctor about loose stools?

How bad do loose stools need to be for it to be a possible sign of bowel cancer?

(Edit: for the women reading this, please also be aware that a change in bowel habit can be a possible sign of ovarian cancer.)

I would class my loose stools as 'mild annoyance', I don't need medical help for them, but just feel I need to be cautious as I know somebody who died of bowel cancer after his GP wrote his persistent loose stools off as stress-related (until the cancer caused a big blockage in his bowel which resulted in him getting diagnosed)

The NHS website says go to your GP if you've had a persistent change in your stools. Well I don't know if mine is persistent? Like, a year ago I *never* had loose stools, a few months ago I started getting occasional loose stools (less than once a week), and nowadays I get loose stools at least a couple of times a week. But even then, I can be pooing normally at one point, then a couple hours later some poo comes out as loose stool.

If I didn't have ME then I'd just ask my GP about it, but I do have ME, and dealing with doctors is so tiring, and even if I see the doctor and they say "that's nothing to be concerned about", I won't know whether I can trust that they're correct about that, or if they're just saying that because they view me as an over-anxious woman?

It is true that as a twenty-something woman I am hardly in the category of people likely to get bowel cancer, but the person I know who died of bowel cancer was a young man in his 30s, which isn't exactly a high risk group either.

Please don't just reply saying talk to a doctor; I will probably do that, but I don't know whether I can trust the doctor to assess me correctly anyway (after all, the guy I know who died of bowel cancer had been told by his GP that his stools probably weren't anything to worry about), so I need to know what their response ought to be, so that I'll know whether I need to get a second opinion!

 

I can't help you @Sarah94 as my problem is more the opposite of yours. But I'm really glad that you felt able to talk about it here, and I very much hope you get some helpful replies. It's horrid to be worried about changes to our bodies but finding it so difficult to actually get to see a doctor. Sending you hugs.

 

I would go. They tend to test your stool anyway, to rule out the Big C. Both my partner and I have been tested (I've been tested twice).

My advice? Don't mention the ME unless asked. Just go in and mention the one thing, let the doctor know you're just checking it out 'to be on the safe side'.

 

You mean they test your poo first, before referring you for a camera inside your bowel?

Is that a "faecal occult blood test"? Because I had that done recently as it was included in a stool test that I did through Genova in the hope of seeing if there was anything in my gut impacting my fatigue. And the faecal occult blood test came up negative. Does bowel cancer always cause a positive result on that test?

 

Hmm, just looked on the NHS website and it says that the faecal occult blood test doesn't guarantee you don't have bowel cancer and you should still see your GP if you have any symptoms of it.

 

Ah, I didn't realise you'd already had that one. But there's another one they can do too.

The camera thing is probably harder to get. They may enquire about other symptoms before referral (e.g., pain).

The best way to find out what to do is check the relevant NICE guideline. If it says 'test for x if y happens', then you'll know if you meet the requirements (which should give you more power to ask for it).

 

Hmm, I've found the NICE guideline, and I wouldn't meet the requirements for referral, unless the doctor felt a mass upon examining my abdomen.

But that isn't particularly comforting, since the bloke that I know who died from bowel cancer, didn't meet the NICE requirements for referral either. Not until his cancer was so advanced that his likelihood of survival was considerably lower.

 

But! Looking back at my Genova stool test results, my fecal calprotectin (a marker of inflammation) is healthily low. "Although a normal fecal calprotectin does have a high negative predictive value for colorectal cancer, no single
biomarker on the GI Effects panel is intended to exclusively rule out or to diagnose cancer."

("Negative predictive value" means that it predicts that you don't have cancer.)

That, at least, *is* comforting. (Especially when you couple it with the fact that I'm in a low risk population group).

I will ask the doctor, but this at least reassures me that I don't need to be worried if the doctor thinks that no further investigations are warranted.

(Or maybe I won't ask the doctor, since I'm fairly certain that based on NICE guidelines they wouldn't refer me anyway.)

 

I was referred twice in two and a half years without this. It's definitely worth going to your doctor and, as @adambeyoncelowe says, focus only on the bowel issue. If you haven't had it before as a symptom of ME, it probably isn't.

I really struggled with it for more than four years, but my problem turned out to be fairly simple: a severe intolerance to potato products. I'd never heard of it before, so it didn't occur to me to try restricting that food group – I knew some people are allergic to potatoes, but I'm clearly not. The GP had given me information about low FODMAP diets etc, but the approach didn't make any difference because I was still eating my beloved spuds. (And honestly, you wouldn't believe the range of products that contain potato starch!)

 

Faecal calprotectin was the second test I meant. That's good.

You can always discuss it with your doctor. Just be prepared that it's harder to get a referral if they don't think you meet the criteria.

They may refer you to a gut clinic or a dietitian more quickly. They at least will help you explore food intolerances.

 

Yeah, having found that in my Genova test results, I'm no longer worried. Will probably ask doctor anyway, but will defer to her opinion of whether or not investigation is needed.

It most likely is a reaction to some minor dietary change, but since its current impact on my quality of life is almost nil, I can't be bothered to go exploring food intolerances. I'm already excluding the foods which seriously impact my quality of life, and that's already making my diet complicated haha.

 

The NICE guidelines for referral are different depending on your age, though:

Refer adults using a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer if:

• they are aged 40 and over with unexplained weight loss and abdominal pain or
  
  
• they are aged 50 and over with unexplained rectal bleeding or
  
  
• they are aged 60 and over with:
  
  
  
  • iron‑deficiency anaemia or
    
    
  • changes in their bowel habit, or
    
  
  
  
• tests show occult blood in their faeces. [new 2015]
  

1.3.2Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults with a rectal or abdominal mass. [new 2015]

1.3.3Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for colorectal cancer in adults aged under 50 with rectal bleeding and any of the following unexplained symptoms or findings:

• abdominal pain
  
  
• change in bowel habit
  
  
• weight loss
  
  
• iron‑deficiency anaemia.
  

 

You can get GI Map stool test done privately - I don't know of NHS does this . We opted for this and it has been illuminating.

Sadly does not mean much to GP but highlights bacterial balance tending to fermenting upper gut, bacterial dysbiosis ( not enough good bacteria) C Diff and drug detox issues

 

Yep that's what I had privately through Genova.

 

I'm 25.

 

You probably already know all this but, based on my own experience, it's probably worth keeping a food / symptom diary. Include all your supplements.
It can provide useful clues to help you decide what to.do next and you may well be asked by your doc, or the person you might be referred to anyway.

The most obvious question is has anything changed since you regularly had "normal" stools? New medication or supplements? It's certainly worth investigating any possible side effects of either.

Again you probably already know that some supplements such as iron and magnesium can cause loose stools. Iron can also cause the opposite in some people.

Food intolerances definitely affect my stools. It can be very difficult to work out the triggers and new ones can develop.

Little things like having a coffee - even a small cup of decaff can make a difference for me.

Hormones definitely affect stools for me too.

When I was less ill and more active my stools were much more consistently "normal". On the same diet but not being able to go for even a small walk I am much more likely to have looser stools.

The above isn't meant to underplay the potential concern or seriousness of bowel issues. Certainly not intended to replace medical advice. Just some ideas that might help identify the issue.

Edited - clarity

 

Absolutely agree with @Invisible Woman, food diary is a great idea.
I had several colonoscopies and an endoscopy and nothing came out of it luckily. But with ME my body is not the same, any day I am intolerant to something that I always have eaten or taken etc. Chemical sensitivities increases and ordinary GP's don't understand this.
I don't get panicky nowadays as I used to be. I had weeks or even months of loose stools/ diarroea and still have them. I am very intolerant of gluten and dairy. It is difficult to avoid them totally unless you prep food incredibly controlled environment.

 

Fecal occult blood tests can give false positives and false negatives under quite a lot of different circumstances. It is possible to reduce the risk of false positives and false negatives but, strangely, patients aren't very often told about them.

The following advice comes from labtestsonline : https://labtestsonline.org.uk/tests/faecal-occult-blood-test-and-faecal-immunochemical-test
Click on all the + signs to see more detail on the above link, except for the first + sign next to "Choose Topic+" which takes you to the search page.

I've actually seen more detailed and specific advice from other places than labtestsonline but can't remember where it came from. It would be worth doing more research on false positives and false negatives in FOBT - Fecal Occult Blood Testing.