Bowel Problems: Constipation, Diarrhoea & Abdominal Pain

Common symptoms

• Opening your bowels less often, straining, or hard stools
• Loose or watery stools for more than a few weeks
• Needing to rush to the toilet (urgency)
• Feeling that you haven’t fully emptied your bowels
• Cramping or pain in the abdomen
• Bloating and excessive wind
• A change from your usual bowel pattern
• Waking at night to open your bowels

Conditions diagnosed and managed

• Chronic constipation
• Persistent or chronic diarrhoea
• Change in bowel habit
• Abdominal pain and discomfort
• Excessive bloating and wind
• Urgency and incomplete emptying
• Bile acid diarrhoea
• Diverticular disease
• Haemorrhoids

Common bowel problems and digestive symptoms

Bowel symptoms are among the most common reasons people see a gastroenterologist — and many people put off seeking help because the subject feels embarrassing. There is no need: these are everyday conversations for a specialist, and most causes are very treatable.

This page is for anyone who has noticed a change and wants it explained, whether or not you have been given a diagnosis.

Chronic constipation

Constipation means passing stools less often than usual, straining, or a feeling of incomplete emptying. Causes include diet and fluid intake, medicines (such as some painkillers), slow movement through the bowel, problems coordinating the pelvic floor muscles, an underactive thyroid and IBS. New constipation in later life should be assessed.

Persistent or chronic diarrhoea

Diarrhoea lasting more than four weeks needs investigation. Common causes include IBS, bile acid diarrhoea, coeliac disease, microscopic colitis, inflammatory bowel disease, medicines, an overactive thyroid and food intolerances. Most can be identified with straightforward tests.

Changes in bowel habit

A lasting change in how often you go, or the consistency of your stools, is one of the most important symptoms to have checked — particularly if you are over 50, or it comes with bleeding, weight loss or anaemia. Usually the cause is benign, but it is important to be sure. See also rectal bleeding and bowel cancer concerns.

Abdominal pain and discomfort

Abdominal pain can come from the bowel, stomach, gallbladder, pancreas or elsewhere. The location, timing and what makes it better or worse all give important clues. A careful history and examination usually narrow down the cause and determine which tests are needed.

Urgency and incomplete bowel movements

Urgency — needing to get to a toilet quickly — and the feeling of incomplete emptying can be caused by inflammation, haemorrhoids, IBS, pelvic floor problems or, less commonly, a growth in the lower bowel. A flexible sigmoidoscopy or colonoscopy is often used to look directly at the bowel.

How Dr Khalid investigates the problem

Dr Khalid will ask about your symptoms, diet, medicines and family history and carry out an examination. Depending on what is found, investigations may include:

• Blood tests, including thyroid function, coeliac antibodies and inflammatory markers
• Stool tests such as faecal calprotectin and FIT (faecal immunochemical test)
• Tests for bile acid diarrhoea where appropriate
• A colonoscopy or flexible sigmoidoscopy, with biopsies if needed
• Imaging such as ultrasound or CT where relevant

Treatment and management

Treatment depends entirely on the cause, and Dr Khalid will explain the findings and options clearly. This may include dietary and lifestyle changes, targeted medicines for constipation or diarrhoea, treatment of an underlying condition such as bile acid diarrhoea or microscopic colitis, and referral to a specialist dietitian, pelvic floor service or colorectal surgeon where that will help.

When should you see a gastroenterologist?

See a specialist if a change in your bowels has lasted more than three or four weeks, if pain or bloating is persistent or getting worse, or if over-the-counter remedies haven’t helped.

Book a private consultation at Spire Cheshire in Warrington or The Highfield Hospital in Rochdale.

Frequently asked questions