Common Symptoms & Investigations

Diarrhoea is loose, watery stools occurring more than three times in one day. It may be accompanied by cramps, bloating, urgency, bleeding and fever. Diarrhoea can be either acute or chronic.

Acute diarrhoea is often related to bacterial, viral, or parasitic infection.

Chronic diarrhoea may be due to inflammatory bowel disease, ulcerative colitis, microscopic colitis or irritable bowel syndrome.

Diarrhoea that recurs, persists for more than a week or is accompanied by blood requires urgent investigation as colorectal cancer can present in this way.

Diagnosis may include taking a consultation and physical examination. Some useful investigations include stool culture, faecal calprotectin, blood tests, colonoscopic examination and SeHCAT study.

Constipation refers to infrequent or hard stools, or difficulty passing stools. Constipation may involve pain during the passage of a bowel movement, inability to pass a bowel movement after straining or pushing for a period of time, or no bowel movements after more than 3 days.

Constipation is most often caused by insufficient fibre in the diet, lack of physical activity, not drinking enough water or repeatedly ignoring the urge to move the bowels. Stress and travel can also contribute to constipation or other changes in bowel habits.

Constipation can be a symptom of irritable bowel syndrome or slow transit constipation. Certain medical conditions can also lead to constipation and it can be a side effect of taking opioid drugs. CT Pneumocolon (virtual colonoscopy) is a helpful investigation.

Less commonly, colorectal cancer can present with constipation or very occasionally as an emergency obstruction with absolute constipation, abdominal distension and vomiting.

Rectal bleeding refers to passage of blood from the anus. Although the bleeding may be coming from the rectum, it also may be coming from other parts of the gastrointestinal tract. The severity of rectal bleeding varies widely and may or may not be accompanied by pain.

Many diseases and conditions can cause rectal bleeding. Common causes include anal fissures, haemorrhoids, cancers and polyps of the rectum and colon, diverticular disease, angiodysplasia, colitis and radiation proctitis.

Diagnosis may be made from a rectal examination, proctoscopy, sigmoidoscopy or colonoscopy. Rectal bleeding in anyone over the age of 40 should be carefully investigated to rule out the possibility of colorectal cancer

The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity.

Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, and pancreas.

Mild abdominal pain is common and is often due to excessive alcohol intake, eating unwisely or an attack of diarrhoea. Abdominal pain that persists or that is not relieved by vomiting or defecating can also be caused by inflammation (for example, appendicitis, diverticulitis, colitis), by stretching or distension of an organ (for example, obstruction of the intestine, blockage of a bile duct by gallstones, or by loss of the supply of blood to an organ. IBS is a very common cause of abdominal cramps and pain. A faecolith in the appendix or adhesions from previous surgery are other common causes of persistent abdominal pain.

The cause of abdominal pain is determined often by either the characteristics of the pain and findings on physical examination. Useful investigations include CT scan and laparoscopy.