Mucus in stool

Specialty: Gastrointestinal.

• Fecal mucorrhoea
• stools with mucus
• anal mucus
• fecal mucus secretion

Why it occurs

• Irritable bowel syndrome (IBS-C or IBS-M subtypes, where mucus is a non-inflammatory reflex secretory response of the colon)
• Active inflammatory bowel disease (ulcerative colitis or colonic Crohn's disease with inflammation of the mucosa and secretion of mucus from colonocytes)
• Infectious colitis of bacterial (Campylobacter, Salmonella, Shigella) or parasitic (Entamoeba histolytica) etiology that generates epithelial damage and reactive mucus
• Giant villous colonic polyps or mucin-secreting colorectal adenocarcinomas
• Microscopic colitis (collagenous or lymphocytic) with chronic inflammation of the lamina propria.

Initial workup

Complete stool culture with Clostridioides difficile toxin investigation, direct fresh parasitological examination and fecal smear | Determination of fecal calprotectin (marker of active intestinal inflammation) | Complete colonoscopy with stepwise biopsies of the terminal colon and rectum | General analysis: blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and iron profile.

Standard management

• Anti-inflammatories with luminal action if distal ulcerative colitis is confirmed — mesalazine 1-1.5 g every 8 hours orally or in suppositories/enemas of 1 g per day depending on the extension
• Ileocolonic or systemic release corticosteroids in moderate outbreaks — budesonide 9 mg/day orally or prednisone 40 mg/day in a descending regimen
• Probiotics with clinical evidence to restore the mucosal epithelial barrier — Saccharomyces boulardii or multispecies mixtures
• Antispasmodics in cases of irritable bowel syndrome (otilonium bromide 40 mg three times a day or mebeverine 200 mg twice a day before meals).