A change in the pattern or consistency of the bowels can be very common. Many patients will experience ‘variability’ in what’s described as their bowel habit and this can be perfectly normal. Indeed, the idea that we should all open our bowel or go to the toilet once a day is a common misconception. Much of this variability will relate to an irritable bowel or IBS which is extremely common. The difficulty, of course, is being able to differentiate between irritability and ‘organic pathology’ or a disease process.

The process of differentiating is made up firstly of establishing precisely what the change has been:

  • What is the background normal, what has happened and for how long?
  • Persistence of ‘change’ over a number of weeks (4 to 6 weeks) is a very good discriminator of disease.
  • Are there associated ‘red flag’ symptoms such as bleeding, abdominal pain or weight loss?

Once a clear picture is established it is then important to try and clarify the diagnosis with some investigations. This might include stool and blood samples, scanning such as ultrasound or CT and endoscopy or camera tests on the bowel. What test are required are dependent on both the age group of the patient, the concern over the pathology and also any story of similar bowel problems in immediate family members.