A Doctor asks a patient how he had got on with the suppositories. The patient replies: 'Frankly Doc, took the lot, for all the good they did, I may as well have shoved them up my bum!'
Unfortunately, some people are too embarrassed to discuss indelicate subjects like the sudden onset of blood loss from their anus. If you notice rectal bleeding, you must consult your GP or health provider. This is not something to be embarrassed about! If the bleeding is non-stop or in large amounts, you should seek immediate emergency care.
Any sudden, unexplained change in pattern of bowel movement is worth having checked out. Tests to find the source of the blood include having a colonoscopy and a barium enema.
Bright Red Blood
If bright red (fresh) blood is on the toilet paper or in the toilet bowl after a bowel movement, it is one of those life-changing moments when you immediately assume the worst and think you are going to die. However, the most likely cause is a haemorrhoid1 (a swollen vein in the anal region) or an anal fissure (a split in the anus). Both cause difficult and painful bowel movements.
Blood on or in the stool may indicate polyps (small, pre-cancerous growths) in the colon. This can become a serious condition known as bowel (aka colorectal) cancer, and early detection from warning signs is vital - 95% of cases are curable if diagnosed early enough. In the UK, bowel cancer is the second highest cause of cancer death after lung cancer. Here are some symptoms, which may include:
- Mucus and/or blood in the stools
- Cramping pain in the abdomen
- Rectal pain
Bleeding that occurs in the intestine may be dark red, brown or almost black. This requires immediate medical attention. Black tar-like stools may be caused by ulcers, alcohol abuse or overuse of drugs like aspirin. Iron pills, prescribed to treat chronic anaemia, can cause hard black stools, but rarely cause bleeding.
Men are statistically more likely to die of colorectal cancer than women, and it is thought that one reason for this is that men are more likely than women to be colour blind2. The link is that if you're colour blind, when you look at a piece of used toilet paper it may all look the same colour, even though there's red and brown on there. Hopefully the other symptoms will prompt the colour-blind person to seek medical attention.
Advice for the over-50s
Age is a factor. If you are over the age of 50, your doctor will probably recommend a colonoscopy routinely. However, for some individuals the risks involved in having a colonoscopy, such as the risk from anaesthesia, can outweigh the benefits, and in these cases a barium enema may be more suitable. The American Cancer Society recommends that everyone has a test for colon cancer at age 50. However, a quarter of people surveyed say their doctor had never discussed colon cancer screening with them, and another quarter said they didn't get screened because they had no symptoms of the disease. Considering colon cancer is the second largest cause of cancer-related death in the US, and bowel cancer is the third most common type of cancer in the UK, it would be prudent not to wait until you do have symptoms, but get yourself checked out anyway. Early detection provides a greater chance of fighting and beating the disease.
The onset of sudden heavy rectal bleeding in the elderly is often caused by diverticulitis. Diverticuli are pouches in the wall of the bowel present in a third of over-60s in the Western world, with diverticulitis being the infection of these pouches. Another possible cause of bleeding in this age range is malformed veins and arteries in the gut wall.
People who have a family history of bowel cancer should be particularly aware and go for routine tests and regular check-ups much earlier than age 50.
Look After Yourself
Prevention is better than cure. Colon cancer is 100% preventable, and diet is the key to this. While cancer cannot be foreseen and can strike anyone anytime, the risks can be reduced by living a healthy lifestyle, which includes a balanced diet with plenty of roughage. Some studies show that having an intake of 35g of fibre a day may reduce the chance of bowel cancer by up to 40%. A high-fibre diet will assist with regular bowel movements. The UK Department of Health has stated that we need 12-20g of fibre on average per day, more if the person is prone to constipation. People with chronic constipation have an almost 80% greater chance of colorectal cancer than those who have regular bowel movements. Drink lots of water (up to two and a half litres/four pints a day, but obviously not all at once) to keep your organs in good condition.
A study showed that women who were taking the RDA (Recommended Daily Allowance) of Folic Acid and Vitamin B6 had a 70% lower chance of colon cancer. Folic Acid is present in dark green leafy vegetables like spinach, and in whole wheat flour, carrots, eggs, yeast and liver. Folic Acid should be taken as a dietary supplement before and during pregnancy. Pyridoxine (vitamin B6), like the rest of the Vitamin B complex, is found in fruits and vegetables, yeast, beef, the dairy products milk, cheese and eggs, and also beer. It is also found in liver but this offal is not recommended for consumption by pregnant women. People who are lactose intolerant or who have special dietary requirements need to take further advice from their health care provider.
Most importantly: do not ignore the symptoms, whether out of fear, embarrassment or ignorance. Your health is your responsibility and you need to keep your body and its inner workings in tip-top condition for a healthy life.
Former England football captain Robert 'Bobby' Moore OBE (1941 - 93) was 46 when he first started having symptoms, but did not seek medical attention straight away - he died from bowel cancer aged 51. His family hold special fundraising events to raise awareness of this preventable disease.
1 These can be removed with a procedure called a haemorrhoidectomy.
2 Approximately ten times more likelihood in men: one male in 20 is colour blind, but only one female in 200 is affected.