Talk with your doctor about any changes in your usual bowel habits, including trouble controlling gas or stool. Be honest and open about all of your symptoms.
If you notice blood in your stool, definitely ask your doctor for further evaluation.
For a thorough evaluation of your symptoms, seek the care of a specialist such as a urogynecologist, colorectal surgeon who specializes in female pelvic floor disorders, or a gastroenterologist. Sometimes you need a team of doctors to help manage different aspects of these conditions. The evaluation should always begin with discussion of your symptoms and a physical examination.
Be ready to discuss when you have bowel problems – how often, how long this has been going on, and what provokes your symptoms. Consider doing a diary of your stools and what you eat. Bring a list of your medications, medical conditions, and prior surgeries.
In addition to a review of your medical history and a physical exam, the doctor may recommend tests such as:
- Colonoscopy / Sigmoidoscopy: Colonoscopy is a procedure done with light anesthesia using a flexible camera to directly visualize and examine the entire colon. Sigmoidoscopy examines only the last part of the bowel near the rectum. These tests help your doctor investigate polyps, areas of narrowing, or even a possible blockage due to cancer or other masses. These tests can also locate a fistula or gastrointestinal disorder such as colitis of Crohn’s disease, which is causing your bowel symptoms. You should be getting these regularly to look for cancer, but if you are having a bowel problem, you may need another test.
- Nerve Testing / Anal Manometry: Nerve testing evaluates possible injury to the nerves, which can cause decreased strength and sensation. Anal manometry is one type of nerve testing. It checks for normal or abnormal sense of bowel filling. It helps your doctor evaluate contraction and relaxation of the pelvic floor muscles. It also examines the sphincter muscle that surrounds the anus and identifies defects in that muscle which might be a part of your problem.
- Defecography: During this test, the mechanics of how you defecate are visualized with radiological studies. This can be done using either x-ray (called fluoroscopy) or magnetic resonance imaging (MRI). A paste is placed into the rectum and sometimes you are given other contrast material through an IV. You then sit on a commode and try to defecate normally. This study can seem unusual, but it is the best study to help the doctors see what is happening on the inside when you defecate.
- Magnetic Resonance Imaging (MRI): This is the best study to look at the muscles near the bowels in the pelvis. It can help your doctor see how the bowels move when you strain
Depending upon your symptoms and evaluation findings, other tests that are sometimes necessary include:
- Endoanal Ultrasound: Evaluates the anal sphincter muscles.
- Barium enema: X-ray study used to look for masses that block the intestines. Doctors look to see how long the contrast stays in your bowels, and sometimes are able to identify a concern for pelvic floor prolapse using this study.
- CT (Computed Tomography) scan: Used to look at the intestines or surrounding tissues for causes of constipation such as masses within or around the intestines.
- Transit Time/Sitz Marker study: Evaluates the time it takes food to move through your bowels. For this study, you swallow a capsule and then several images are taken in the days afterward to see how far some markers have moved through your bowels.
Did you know?
Women 50 or older need colon cancer screenings. The best screening, particularly for women, is a colonoscopy. Additional screening tools include sigmoidoscopy, barium enema, and testing of the stool for blood.