I was chatting with a patient the other day about cultural differences in the shape of toilet bowls. I have never understood the appeal of seeing the log you have just produced, laid out on a pristine white shelf for you to examine.
She was pointing out that it was difficult for her to answer my questions about blood in her motions, when she was unable to see them before they disappeared around the U bend. It made me think of an interesting research question; are bowel cancer survival rates better in countries where the shape of the toilet bowl allows the population to study their stools?
I may sound flippant, but actually we should probably talk more about our bowel movements, and most of us don’t. There are times when it becomes a daily topic of conversation, for example when backpacking around India:
“Oooh, that was a bit more solid today, thank goodness”.
There are also times when others’ bowel movements are discussed regularly:
“Hi Mum, is it normal that his nappies were really green today?”
But many of us feel uncomfortable talking about it, and I had to experiment a little with what words to use in this article; stools, motions, poos, bowel movements etc. Normally I would choose different words depending on the patient.
However, if you have had persistently looser motions for a few months, it could be an early sign of bowel cancer, and many of us are unaware of what to look out for and when to seek advice from a doctor.
What to look out for
Bowel (colorectal) cancer is the third most common type of cancer diagnosed, and the third biggest cause of cancer deaths. 1 in 20 of us may develop bowel cancer in our lives, and the risk is slightly higher in men than in women. Most cases occur in the over 50s, but it does happen in younger people too, so everyone needs to be aware.
So what are the symptoms? The ones to look out for are as follows:
- Bleeding from your bottom or blood mixed in with your stools.
- A change in the consistency of your motions, or the frequency at which you go which lasts for more than 3 weeks, especially if it is a change to runnier and more frequent.
- Unexplained weight loss.
- Unexplained severe tiredness
- Persistent pain in your tummy or a lump.
Obviously all these symptoms could be due to a multitude of different things, but it is certainly worth making an appointment with your doctor if you have any of those.
But surely we should be looking at preventing bowel cancer, or picking it up at a really early stage? As with many other cancers, there are some basic rules that will help you to avoid bowel cancer.
What you eat is hugely important to your general health, but especially important to the health of your colon. A diet that is high in fibre, with plenty of fresh fruit and vegetables will help to avoid problems. You should also aim for a diet that is low in fat and does not include too much red or processed meat (such as ham and sausages).
Regular exercise has been shown to reduce your risk of bowel cancer, and current guidelines suggest that we should all be aiming for 20-30 minutes a day of doing something that makes us slightly out of breath – and that can include energetic vacuuming or very vigorous sex!
Following the first 2 items above should help you to maintain a healthy weight. Smoking is obviously the worst sin when it comes to all forms of cancer, and bowel cancer is no exception. It doesn’t look cool, it makes your breath smell, your teeth go yellow, your skin age prematurely, and it puts you at risk of heart disease and stroke as well as numerous cancers, so pack it in!
Stick to the recommended weekly maximums for alcohol consumption. That is 21units for men and 14 for women, one unit being a small glass of wine, a small beer or a single measure of spirits.
The screening option
So your halo is now shining and you are living healthily, but is there anything else you can do to help detect any problems early?
Yes, you can take part in the screening that is offered here in Luxembourg. At the age of 50, your doctor can refer you for a screening colonoscopy. This involves a few days of special diet and a concoction of laxatives to give you a really good clear out – perhaps you can skip your appointment for colonic irrigation that month! A small camera is then passed through your anus and around your large intestine, allowing any small polyps, which could go on to develop into cancers, to be removed.
OK, perhaps it is not how you would choose to spend an afternoon, certainly shopping or a nice facial would be more fun, but it is an extremely effective way of screening for colon cancer and if it is all clear, it only needs to be repeated at the age of 65. The alternative would be to send off a series of 3 stools samples each year to be tested for blood. This is not such an effective screening test (more likely to miss the occasional cancer or detect problems which turn out not to be cancer) but is still a reasonable thing to do, and better than no screening.
If members of your family have had bowel cancer, this could mean that you are at increased risk, so this should be discussed with your doctor.
So, though we may be reluctant to talk about it, and some of us prefer not to study what comes out of it, it is really important to care for your colon. It could save your life.
By Susie Tunstall-Pedoe, March 2013