Q. I have severe constipation with red mucus in the stools. Kindly advise on the relevant tests.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 19, 2021

Hi doctor,

I am 29 years old. I have always had bowel movement issues for as long as I can remember, not having a movement for five days. About a year ago, I noticed some blood in my stool on a few occasions. I went to the GI doctor, and he ran multiple tests (fecal calprotectin, FIT, abdomen CT scan, abdomen X-ray, blood work), all of which were normal. He suggested a colonoscopy because that was typically the only way he could see what is going on. I will say that I have major anxiety or panic attack disorder, so I was terrified to undergo this procedure. My main concern is colon cancer. I do not have any family history of this disease, but I do suffer from health anxiety and always assume the worst. So I asked him what my other options were to rule out colon cancer. He said the cologuard test is almost just as accurate as a colonoscopy for detecting colon cancer but not as accurate to detect polyps. So I did this test, and again, it was negative.

However, that was five months ago, and I cannot seem to stop worrying. Since then, I have only had one bout of loose stools with reddish looking mucus, but no other issues. What are your thoughts?



Welcome to icliniq.com.

It seems chronic constipation. Your anxiety may or may not be contributing to this constipation. Possible causes of constipation of that much duration seem to be due to chronic idiopathic constipation (CIC), of pelvic dyssynergia or also called anismus or dyssynergic defecation. In CIC, the bowels are extremely slow, and in the dyssynergic defecation, there is an asynchronous and paradoxical contraction of the abdominal and pelvic muscles when you defecate.

I would need answers to my following questions before I can differentiate among the above two and guide you on which test you do to diagnose it and suggest some treatment.

Yes, Cologaurd is a good test, and it is sensitive in detecting colon cancer. And secondly, your age and family history keeps you at very low risk for having colon cancer. The blood in stools can be due to anal fissure, hemorrhoids, or solitary rectal ulcers. All are common in chronic constipation. This would probably heal or go away once your primary problem of constipation is taken care of.

Do you strain much at passing stools? Do you have abdominal or rectal pain, pain after or while passing stools? Do you sit in the restroom for half to one hour before you able to pass stools? Do you feel urge regularly, like once or twice in the morning, or have the frequent urge? or no urge of passing stools like days before you feel urge? Have you ever used a finger or enema to remove stools from the rectum manually? Does changing posture in the restroom help you to pass stools? How much fiber and water you take in a day?

Thank you doctor,

Yes, I go from constipation to loose watery stools frequently. I do not drink enough water and probably do not eat enough fiber. I started taking probiotics about nine months ago and have been pretty regular since then, going only two to three days without having a bowel movement (which is an improvement). But I do still have loose bowels occasionally.

I occasionally strain, but not too much anymore since being on probiotics. I do drink coffee regularly, so that helps me get the urge to go. If I put my knees up, it is easier to have a bowel movement. Did you see the photo I attached? I am not sure if it is blood or mucus. Do you think I need to be worried about cancer?



Welcome back to icliniq.com.

Yes, I have seen both photos (attachment removed to protect patient identity). It is mucus and not blood. But it is an abnormally significant amount of mucus. This again can occur with rectum irritation, which can be due to hard stools or ulcers in the rectum, which in turn can occur in solitary rectal ulcer syndrome (SRUS), of stool induced ulcers called stereo ulcers.

Secondly, your stools are formed, and previously late bowel movements, and now improved within two to three days, suggest more constipation. Intermittent loose stools, especially after the use of laxatives, are common among chronically constipated individuals. This condition is called spurious diarrhea meaning false diarrhea. I think the first step would be to improve your fiber intake by taking fruits, green vegetables, and water for approximately two to three liters. Plus, use Isabgol husk two tablespoons full with water on an empty stomach every day. Expect to have one BM (bowel movement) at least every day. You can use probiotics no issue with that.

You may have chronic idiopathic constipation, which should resolve with the above recommendations. If it does not improve, we would consider some testing.

Get a TSH (thyroid-stimulating hormone), T4 in blood, if not done earlier. Let me know the reports once available.

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