When a gut feeling could be a problem
6 April 2020
April is the awareness month for both bowel cancer and irritable bowel syndrome (IBS).
Both can present with similar symptoms, although there is no evidence to suggest that one leads to the other, but it makes sense for both conditions to share the same awareness platform.
If your doctor says that you need endoscopy to investigate symptoms, you can ask to be referred to us to have your tests done.
Bowel cancer is an over-arching term for cancer which starts in the large colon. Most people who are diagnosed with bowel cancer are aged over 60 years. Symptoms are subtle and often those affected do not feel ill, but almost all will experience some or all of the following symptoms:
- Ongoing changes in bowel habits, such as looser stools (needing to go to the loo more frequently) and abdominal pain
- Blood in the stools where haemorrhoids (piles) are not present – they can often be the source of bleeding
- Pain, discomfort or bloating after eating
- Unintended weight loss
The symptoms are very common and do not necessarily mean the presence of bowel cancer, but you should see your GP if they persist for more than four weeks. You should also see your GP if the symptoms come back after treatment.
When you see your GP they will do a number of things:
- Ask you if you have a family history of bowel cancer
- Carry out a quick anal examination to check for lumps
- Examine your tummy for lumps
- Check your blood for iron deficiency (caused by blood loss, not by a suspected cancer)
If your GP thinks that you need an examination of your bowel to help diagnose the cause of your symptoms, he or she will refer you to hospital for further investigations. These can include:
- Flexible sigmoidoscopy, an examination of the rectum and a small part of the large colon using a sigmoidoscope. This is a long, thin tube attached to a small camera with a light. The camera sends images to a monitor so the doctor can see inside the rectum. Biopsies can also be taken. It is important that your lower bowel is empty before the investigation, so you will be asked to give yourself an enema at home at least two hours before you leave. Flexible sigmoidoscopy can be uncomfortable, but is not painful, but it only lasts for a few minutes and you can go home immediately after the procedure.
- A colonoscopy is carried out using a longer tube and is an investigation of the whole large bowel. It takes about 30 minutes to complete and some patients are given a sedative to help them relax during the test. The bowel needs to be empty before the test, so patients are given a special ‘low residue’ diet for a few days beforehand and some laxatives during the 48 hours prior to the examination. Patients can go home once the sedative has worn off but they may well still feel drowsy, so it is advised that someone should be available to take them home. Older people should have someone with them for 24 hours after the test, and driving should also be avoided for 24 hours.
- CT colonoscopy is used in the small number of instances where it has not been possible for the colonoscope to access all the large bowel, or where other medical reasons have made it difficult. The procedure is carried out in a Radiology department, using a CT Scanner. During the procedure, gas is used to inflate the bowel using a thin, flexible tube placed in the rectum and several scans are then taken from a number of different angles. As with a colonoscopy, a special diet and laxatives before the test will be necessary. You may also be asked to take a liquid called gastrograffin before the test. A CT colonography is a less invasive test than a colonoscopy, but colonoscopy or flexible sigmoidoscopy may be required at a later date if any biopsies are needed, or any polyps require removal.
IBS is a common condition that causes uncomfortable and inconvenient symptoms such as stomach ache, gripey pains, wind (causing bloating), with diarrhoea and/or constipation. It can become a lifelong condition and has no known cure, but medication and an appropriate diet can alleviate symptoms.
Symptoms are not present all the time but come and go, and many people can identify triggers which may cause the gut to become more irritable. No one truly knows what causes IBS but it has been linked to the speed (or slowness) of food passing through the gut, stress, a family history of irritable bowel, or sensitive nerves in the gut.
If you think you might have IBS it is advisable to see your GP so that he or she can rule out any other problems. If you experience the following symptoms you should ask for an urgent appointment:
- Unplanned weight loss
- A hard lump or swelling in your abdomen
- Blood from your bottom or in diarrhoea
- Pale skin
- A shortness of breath
Your GP will take a blood test to rule out coeliac disease (a lifelong disease caused by diagnosed autoimmune reaction to gluten), and ask for a sample of your faeces so that it can be tested for inflammatory bowel disease. If your GP thinks there is anything more serious to your condition, he or she may refer you for the further investigations described in the section on bowel cancer. This does not necessarily mean that you have bowel cancer, it is just that your doctor has referred you for these investigations to find out what might be causing your symptoms.