SymptomsAbdomen and digestion

Constipation and diarrhoea: which doctor should I see?

Constipation means passing stools rarely, with difficulty or with pain, and diarrhoea means frequent, watery or loose stools. The two can also alternate. They often pass on their own, but blood in the stools and a lasting change in bowel habits should be examined. Here you will learn what may be behind them, when it is urgent and which specialist to see.

Book a specialist

When it is urgent

Sudden, severe abdominal pain. Or your belly hurts and you cannot pass urine at all, or you cannot pass stools or wind at all.
You vomit blood, material like coffee grounds or like stools, or green matter — in a child, also yellow-green matter.
Bleeding from the anus does not stop or is heavy, for example the toilet water turns red or there are large clots, or your stools are black and sticky like tar.
Confusion, unusual sleepiness or being hard to wake, fast or difficult breathing, pale, grey, blue, blotchy or cold skin, or a rash that does not fade when pressed.
A child with diarrhoea or vomiting has not passed urine (no wet nappy) for twelve hours, has very sunken eyes, is unusually listless or not responding as usual, has a weak, high-pitched or constant cry, or has a seizure. In a baby under three months, a temperature of thirty-eight degrees Celsius or more, or below thirty-six degrees, is also an emergency.
A stiff neck and eye pain in bright light, or a sudden, severe headache. In a child with a fever, just one of the first two signs is enough.
You suspect poisoning — for example from unknown mushrooms or a household chemical — in yourself or your child.

With these signs, seek emergency help — call 112 or go to the nearest emergency department.

Call 112

What it may mean

A stomach bug or food poisoning — sudden diarrhoea, often with nausea, vomiting and stomach cramps.
Diet and lifestyle — too little fibre and fluid, too little exercise, a change in routine or stress often lead to constipation.
Side effects of medicines — some medicines cause constipation, others diarrhoea.
Irritable bowel — abdominal pain and bloating with constipation, diarrhoea or both in turn.
Inflammatory bowel disease — long-lasting diarrhoea, sometimes with blood or mucus. A food intolerance can also cause diarrhoea and bloating, but it does not explain blood in the stools.
Less often, diverticula or bowel cancer — which is why blood in the stools and a lasting change in bowel habits should be examined.

Which specialist

Gastroenterologist in Sofia

How to prepare for the visit

Note how long you have had the complaints, how often you go to the toilet, what your stools are like and whether there is blood or mucus. Note what you have eaten, whether anyone around you has the same complaints and whether you have travelled. Bring earlier test results and a list of the medicines you take — do not stop prescribed ones without talking to the doctor. The doctor may ask for a stool sample.

A specialist visit paid by НЗОК (NHIF) usually needs a referral from your GP; a referral is valid for 30 days. A paid visit is possible without one.

Frequently asked questions

When are constipation or diarrhoea a reason for a visit?

When they do not improve, keep coming back, or your bowel habits change and do not return to normal, and with blood in the stools, abdominal pain, weight loss for no reason or constant tiredness. Book a visit without delay if you have bloody diarrhoea or dark red stools, you vomit and cannot keep fluids down, you have signs of dehydration — dark, scanty urine or dizziness on standing that does not pass — or the diarrhoea lasts more than a week or the vomiting more than two days.

When should a child with diarrhoea or constipation see a doctor?

For constipation in a child, ask your GP or the paediatrician. Book a visit without delay if a child with diarrhoea stops breast or bottle feeding, eating or drinking, vomits and cannot keep fluids down, has blood or mucus in the stools, a high fever or fewer wet nappies, cries without tears, has a sunken soft spot on the head or is not getting better. A baby under six months with diarrhoea should see a doctor; if you are worried about a baby under one year, call the doctor the same day.

Gastroenterologist or paediatrician?

The first step is usually your GP, who will examine you, may order tests and refer you. For long-lasting constipation or diarrhoea, blood in the stools or a lasting change in bowel habits, the specialist is a gastroenterologist. For a child, a paediatrician.

This information does not replace a visit to a doctor.