![]() Such unwarranted referrals expose the patients to unnecessary risks and discomforts and put a strain on an already over-stretched healthcare resources. Since diarrheal states are much more common than CRC, in the absence of authentic symptomatology of CRC, such as rectal bleeding, change in the bowel habit, tenesmus, left-sided abdominal cramps, anemia, etc., the referral of these patients for colonoscopy based solely on "decreased stool caliber" is unwarranted. Our own everyday experience shows that low caliber stool is noticed whenever we have loose stool. Nevertheless, this misconception somehow permeated the standard textbooks of medicine and even the newer editions of text-books of gastroenterology. ![]() In the absence of reliable data to support this concept, the authors of gastroenterology textbooks in the mid-twentieth century practically dismissed the concept. ![]() presence of tumor results in narrowing of the colon, which in turn decreases the caliber of the stool-was conceived late in the nineteenth century. However, narrow or pencil-thin stools may also indicate an underlying condition, such as irritable bowel syndrome or colorectal cancer. Certain cancers may partially obstruct the bowel and produce pencil thin stools. An anal fissure is an example of a condition that can produce painful bowel movements. A review of the literature reveals that this rather lay misconception-i.e. Painful bowel movements can occur in the presence of inflammation or injury in the anal canal. Over the past several years, primary care providers have been referring a large number of their patients to gastroenterologists for colonoscopy because of "low caliber stool" or "pencil thin stool." Most textbooks of internal medicine and gastroenterology consider "small caliber stool" as one of the presenting signs of colorectal cancer (CRC). ![]()
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