The Bowels, The Bowels

The bowels, the bowels

A phrase of which Quasimodo was particularly fond. Although we do not generally discuss it, we all have a bowel habit. For some it might be once a day, others three times a day and yet others once a week.

If there is a change in our habit, we can usually identify a cause. This might be a curry, a night on the beer or a course of antibiotics. Such changes are usually brief and revert to type within a week.

Some peoples’ normal habit is a mixture of constipation and diarrhoea as is often the case with irritable bowel syndrome.   One in five people suffer from this condition, usually from their teenage years or before. Although benign it can cause pain, bloating and misery for some. There is some excellent information on the condition and its management at this link  https://patient.info/digestive-health/irritable-bowel-syndrome-leaflet.

Given that for at least the remaining 4 in 5 of us, our habit does not change much, what should we do if it changes?

It is unusual to develop irritable bowel syndrome after our 30s. So never just assume that you have developed irritable bowel syndrome later in life.

So, what do doctors have to think about when someone presents with a change in habit? Well, one of the more serious concerns is that it relates to a bowel cancer. NICE have provided guidance on who to refer for bowel investigation. https://cks.nice.org.uk/gastrointestinal-tract-lower-cancers-recognition-and-referral#!scenario

Essentially, depending on your age, you should be referred urgently if you have unexplained weight loss and abdominal pain. Unexplained bleeding over the age of 50 and if aged over the age of 60, any of the above, but also iron deficiency anaemia and or, a change in bowel habit. We would consider referral even for those with symptoms under the age of 50.

Problems with the ovaries, in the form of ovarian cancer, can also cause bowel symptoms, looseness or constipation, bloating, pain or early fullness after eating. So do not ignore bloating if it is a new symptom.

Pancreatic cancer can present with weight loss, change in bowel habit, abdominal or even mid back pain.

More benign conditions can cause prolonged diarrhoea. Giardiasis, usually picked up abroad from infected water supplies, causes bloating and looseness of the bowels. Amoebiasis causes similar symptoms as well as weight loss. Both are treated with antibiotics and diagnosed from examination of a stool sample.

Inflammatory bowel disease, colitis or crohns disease, often affects younger age groups and can present with pain, bloating, bleeding, diarrhoea or constipation. It is diagnosed by taking a small sample of bowel during a telescope test called a colonoscopy and there are numerous possible treatments to keep these conditions under control.

Coeliac disease is now commonly discussed. It is an intolerance to gluten, a substance found in wheat. The body produces antibodies that fight the lining of the small bowel. This leads to a failure to absorb nutrients leading to weight loss, diarrhoea, weakness, loss of bone density and vitamin deficiencies. This in turn can lead to a myriad of symptoms, relating to abnormal nerve activity.

So, there are lots of possibilities to consider but the moral is, most of us have a bowel habit that is part of who we are. If it changes for more than a week or two, seek advice from your doctor. A blood test can be the first step in checking your bowel health. Referral to a specialist for a Colonoscopy is always advisable if there is no history of piles or fissures.

In many countries a colonoscopy is offered as a screening test to people over the age of 50. Many rectal tumours start as polyps which are easily detected via a Colonoscopy and can be removed before they cause problems. These often run in families. If you have concerns get in touch and we can advise on the best course of action