Introduction

Change in faeces or bowel movements refers to any alterations in the frequency, consistency, color, or odor of stool. It is a common symptom that can be caused by various factors, ranging from dietary changes to underlying medical conditions.^[1] This guide aims to provide an overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle modifications related to changes in faeces/bowel movements.

Codes

• ICPC-2 Code: D18 Change in feces/bowel movements^[2]


• ICD-10 Code: R19.4 Change in bowel habit^[3]

Symptoms

• Diarrhea: Frequent loose or watery stools.


• Constipation: Difficulty passing stools, infrequent bowel movements.


• Changes in stool color: Stool may appear pale, black, or bloody.


• Changes in stool consistency: Stool may be hard, loose, or contain mucus.


• Changes in stool frequency: Increased or decreased frequency of bowel movements.


• Abdominal pain or cramping: Discomfort or pain in the abdominal region.


• Bloating or gas: Feeling of fullness or increased gas production.^[4]

Causes

• Dietary changes: Consuming certain foods or beverages can affect stool consistency and frequency.


• Medications: Some medications can cause changes in bowel movements, such as antibiotics, laxatives, or antacids.


• Infections: Bacterial, viral, or parasitic infections can lead to diarrhea or changes in stool color.


• Digestive disorders: Conditions like irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), or celiac disease can cause changes in bowel movements.


• Intestinal obstruction: Blockage in the intestines can lead to constipation or changes in stool consistency.


• Hormonal changes: Hormonal imbalances, such as those occurring during pregnancy or menopause, can affect bowel movements.


• Stress or anxiety: Emotional factors can influence bowel movements.


• Medical conditions: Certain medical conditions, such as thyroid disorders or diabetes, can cause changes in bowel movements.^[5]

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the duration, frequency, and severity of changes in bowel movements.


• Inquire about any recent dietary changes, medication use, or travel history.


• Assess the presence of other symptoms, such as abdominal pain, bloating, or weight loss.


• Identify any risk factors or underlying medical conditions that may contribute to changes in bowel movements.^[6]

Physical Examination

• Perform a comprehensive physical examination, focusing on the abdomen to assess for tenderness, distension, or masses.


• Check vital signs, including temperature, heart rate, and blood pressure.


• Evaluate the patient’s overall appearance and signs of dehydration or malnutrition.^[7]

Laboratory Tests

• Stool analysis: Collect a stool sample to check for the presence of infection, blood, or other abnormalities.


• Blood tests: Measure blood cell counts, electrolyte levels, liver function, and markers of inflammation.


• Celiac disease testing: Screen for antibodies associated with celiac disease if gluten intolerance is suspected.


• Thyroid function tests: Assess thyroid hormone levels to rule out thyroid disorders.


• Diabetes screening: Measure fasting blood glucose levels to evaluate for diabetes.^[8]

Diagnostic Imaging

• Abdominal X-ray: May be used to identify signs of intestinal obstruction or other structural abnormalities.


• Abdominal ultrasound: Provides detailed images of the abdomen to assess the organs and detect any abnormalities.


• CT scan: Offers cross-sectional images of the abdomen to evaluate the gastrointestinal tract and surrounding structures.


• Colonoscopy or sigmoidoscopy: Invasive procedures that allow direct visualization of the colon and rectum to detect any abnormalities or take biopsies.^[9]

Other Tests

• Food intolerance testing: Identify any food intolerances or allergies that may be causing changes in bowel movements.


• Hydrogen breath test: Assess for conditions like lactose intolerance or small intestinal bacterial overgrowth (SIBO).


• Endoscopy: Invasive procedure that allows visualization of the upper gastrointestinal tract to identify any abnormalities or take biopsies.^[10]

Follow-up and Patient Education

• Schedule follow-up appointments to monitor the patient’s progress and adjust treatment if necessary.


• Provide education on dietary modifications, medication use, and lifestyle changes to manage changes in bowel movements.


• Encourage the patient to maintain a symptom diary to track any patterns or triggers related to their bowel movements.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for changes in faeces/bowel movements:

1. Loperamide (Imodium):
   
   
   
   • Cost: $5-$15 for a pack of 24 tablets.
   
   
   • Contraindications: Allergy to loperamide, abdominal pain without diarrhea, bloody or black stools.
   
   
   • Side effects: Constipation, dizziness, drowsiness.
   
   
   • Severe side effects: Severe constipation, allergic reactions.
   
   
   • Drug interactions: None reported.
   
   
   • Warning: Do not exceed the recommended dose or use for more than 2 days without medical advice.
   
   
   
   


2. Psyllium (Metamucil):
   
   
   
   • Cost: $10-$20 for a 48-ounce container.
   
   
   • Contraindications: Allergy to psyllium, difficulty swallowing, intestinal blockage.
   
   
   • Side effects: Bloating, gas, stomach cramps.
   
   
   • Severe side effects: Allergic reactions.
   
   
   • Drug interactions: None reported.
   
   
   • Warning: Take with plenty of water and follow the recommended dosage.
   
   
   
   


3. Bismuth subsalicylate (Pepto-Bismol):
   
   
   
   • Cost: $5-$10 for a 16-ounce bottle.
   
   
   • Contraindications: Allergy to salicylates, bleeding disorders, children or teenagers recovering from viral infections.
   
   
   • Side effects: Darkening of the tongue or stool, constipation.
   
   
   • Severe side effects: Reye’s syndrome (in children recovering from viral infections).
   
   
   • Drug interactions: None reported.
   
   
   • Warning: Do not use for more than 2 days without medical advice.
   
   
   
   


4. Probiotics (e.g., Lactobacillus, Bifidobacterium):
   
   
   
   • Cost: $10-$30 for a 30-day supply.
   
   
   • Contraindications: None reported.
   
   
   • Side effects: Gas, bloating, mild stomach upset.
   
   
   • Severe side effects: None reported.
   
   
   • Drug interactions: None reported.
   
   
   • Warning: Choose a reputable brand and follow the recommended dosage.
   
   
   
   


5. Antispasmodics (e.g., Dicyclomine, Hyoscyamine):
   
   
   
   • Cost: $10-$30 for a 30-day supply.
   
   
   • Contraindications: Glaucoma, urinary retention, myasthenia gravis.
   
   
   • Side effects: Dry mouth, blurred vision, dizziness.
   
   
   • Severe side effects: Rapid heartbeat, difficulty urinating.
   
   
   • Drug interactions: None reported.
   
   
   • Warning: Take as directed and avoid alcohol or other sedatives.
   
   
   
   

Alternative Drugs:

• Lubiprostone (Amitiza): Used for chronic idiopathic constipation or irritable bowel syndrome with constipation. Cost: $300-$400 for a 30-day supply.


• Rifaximin (Xifaxan): Antibiotic used for travelers’ diarrhea or irritable bowel syndrome with diarrhea. Cost: $1,200-$1,500 for a 14-day supply.


• Linaclotide (Linzess): Used for chronic idiopathic constipation or irritable bowel syndrome with constipation. Cost: $300-$400 for a 30-day supply.


• Alosetron (Lotronex): Used for women with severe diarrhea-predominant irritable bowel syndrome. Cost: $300-$400 for a 30-day supply.


• Eluxadoline (Viberzi): Used for irritable bowel syndrome with diarrhea. Cost: $300-$400 for a 30-day supply.

Surgical Procedures:

• Surgery is typically not indicated for changes in faeces/bowel movements unless there is an underlying condition that requires surgical intervention, such as intestinal obstruction or colorectal cancer.

Alternative Interventions

• Acupuncture: May help improve bowel function and reduce symptoms. Cost: $60-$120 per session.


• Herbal supplements: Certain herbs, such as peppermint oil or ginger, may have potential benefits for digestive health. Cost: Varies depending on the specific supplement.


• Probiotic foods: Consuming foods rich in probiotics, such as yogurt or sauerkraut, may help restore gut flora. Cost: Varies depending on the specific food.


• Mind-body techniques: Practices like yoga, meditation, or deep breathing exercises can help reduce stress and improve digestion. Cost: Varies depending on the specific practice.


• Dietary modifications: Adjusting the diet to include more fiber, fluids, and avoiding trigger foods may help regulate bowel movements. Cost: Varies depending on individual food choices.

Lifestyle Interventions

• Regular exer