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When a gut feeling could be a problem

April 9 2018

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
 
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
 
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
  • Palpitations
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.
 
5 signs you may need an endoscopy
 
An endoscopy is when a tube with a camera and a light is inserted into your body through your mouth, nose or anus to help identify and diagnose the cause of a variety of symptoms.
 
Why might you need an endoscopy? Here are five signs to look out for and to discuss with your GP:
 
  • Stomach pain – if you are experiencing pain in your abdomen which is unusual or which lasts for more than a few hours, it could be symptomatic of an illness or condition. You should see your GP who may refer you for an endoscopy procedure to diagnose the cause of the problem.
  • Blood in your stools – this may be the sign of several conditions one of which may be bowel cancer. If bowel cancer is diagnosed early, it can be treated. If you notice any blood in your stool or when you wipe yourself after going to the toilet you should see your GP who may suggest one of the endoscopy procedures described earlier in this article.
  • Difficulty swallowing your food – also called dysphagia. This can be caused by a number of conditions ranging from an infection or inflammation, to cancer of the oesophagus. If symptoms persist you should see your GP quickly and he/she may decide an endoscopy is required.
  • Acid reflux/heartburn – we have all suffered heartburn at some point and antacids help, but if you are experiencing heartburn or acid reflux regularly or over a long period of time it may be caused by an underlying condition. Long term acid reflux can also lead to Barrett’s oesophagus, where the abnormal growth of cells causes blockages. If your experience of acid reflux or heartburn is long term it should be discussed with your GP who may refer you for an endoscopy to investigate the cause of the problem.
  • Irregular bowel movements, long term constipation or diarrhoea – sometimes these symptoms can be caused by a change in diet or lifestyle and may settle, but if you experience them for a long period of time they may be signs of something else such as IBS, colon cancer or an underactive thyroid. Speak to your GP who may think it is appropriate for you to have an endoscopic investigation.
Whatever your symptoms, always speak to your GP if you’re worried.