Dr Alan Watson, Consultant Gastroenterologist and Physician answers your frequently asked questions on ‘normal bowel habits’

In our latest Ask the Consultant article, featured in West Essex Life Magazine, Dr Alan Watson, Consultant Gastroenterologist and Physician answers your frequently asked questions on ‘normal bowel habits’. You can read the full article here.

Let’s face it, discussion of one’s bowel habit is hardly the stuff of polite conversation, even for the least bashful. Most people would not even dream of discussing this important aspect of our health with anyone except our doctor or closest confidante. However we can’t escape the fact that intestinal function is really very important to overall health and wellbeing.

What is a ‘normal’ bowl habit?
Our bodies are as different on the inside as on the outside. ‘Normal’ really should mean ‘normal for you’. Some people are more frequent than others, some tend towards constipation. Likewise, stool consistency can be extremely variable. ‘Normal’ bowel habit can mean anything between twice a week up to 3 times per day in otherwise healthy people. There are even a large number of people that have a rather changeable bowel habit.

What causes changes to my intestinal function?
Every day the intestines process a huge variety of different foods, liquids, medicines and hormones that effect gut function. Certain types of foods can cause an increased gas, but almost anything in the diet can also contribute to bloating, bowel habit change and even abdominal pain. The amount of fibre, fluids, protein and processed foods are important. Ageing and the menopause may also affect intestinal function, as can stressful events.

What is actually meant by a ‘change in bowel habit’?
A change in bowel habits means a persistent and unexplained alteration in bowel function. This is typically for a period of more than a few weeks, including looser or harder stools, pain in the abdomen, a change in the colour of the stool or the presence of blood.

When should I see a doctor?
If you are concerned about any intestinal health problem, it is best to seek advice earlier rather than later. Most abdominal complaints are entirely harmless and can be dealt with easily and effectively. So-called ‘alarm symptoms’ which should prompt early medical attention include bleeding, persistent change in bowel habit, pain that occurs at night or in a particular area of the abdomen. Unplanned weight loss may also be a sign of serious internal disease.

What happens during a consultation with a consultant gastroenterologist?
During your consultation, you will be asked in detail about your symptoms and given time to explain everything to the doctor in detail. Any previous investigations can be reviewed and explained in full. You will be asked about your medical history and medications that you take, as well as any family history of intestinal disease such as polyps, ulcers, inflammation and cancer. You may also have a physical examination. When completed, the doctor will let you know their initial thoughts and a likely diagnosis and will give recommendations regarding further investigations or treatments.

What tests are usual to investigate intestinal disease?
A detailed consultation with an expert is likely to give a good indication as to what may be wrong but further tests are often required to confirm or exclude particular conditions. Blood and stool tests give clues as to blood loss, inflammation or biochemical abnormalities. Ultrasound, CT and MRI scans give excellent views of the internal organs to identify abnormalities. Endoscopy and colonoscopy examinations involve a small, flexible camera to examine the interior of the stomach, intestine or colon (the large bowel). These examinations are often key to effective diagnosis and treatment as they allow close inspection and for biopsies or polyps to be removed. Although certainly not very glamorous, endoscopic examination is not as worrying or uncomfortable as many might fear!

Should I be screened for bowel cancer?
Bowel cancer screening can prevent bowel cancer by detecting and removing polyps from the colon. Polyps are benign growths in the bowel that can increase in size and develop into bowel cancer. Polyps often don’t give any symptoms, but can be detected by finding invisible amounts of blood in the stool. In the UK, the over 60s take part in the National Bowel Cancer Screening Programme and submit a stool sample for analysis, whereas in other countries, the recommendation is for colonoscopy aged 50, followed by regular screening. People that have a family member with polyps or cancer are at a higher risk of bowel cancer and should discuss this with a gastroenterologist with expertise in colon cancer screening.

What can I do to improve my intestinal health?
Moderation is the key. The best advice is to take a varied, healthy diet with plenty of fruit and vegetables. Sugar and fat and alcohol are not necessarily harmful in moderation and can make eating the pleasurable, social experience that it should be. Smoking and obesity increase the risk of many difference diseases, including polyps and bowel cancer and should be avoided if at all possible.

Should there be any concerns, an expert gastroenterologist will advise, reassure, investigate and treat with utmost discretion and understanding.

Dr Alan Watson is a Consultant Gastroenterologist and Physician at The Holly Private Hospital and Barts Health. He has expertise in all aspects of intestinal and liver disease and is accredited by the National Bowel Cancer Screening Programme. He has clinics at The Holly on Mondays, Tuesdays and Thursdays.