What do my symptoms mean?
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Bowel symptoms can be alarming and cause suffering but at the same time
many patients find it embarrassing to talk about them, even to family
members or even their own doctors.
The main thing to emphasize is that most bowel symptoms are caused
by benign conditions which are easily treatable.
The most alarming symptom which brings the patient to the doctor is
bleeding from the rectum. The first thing to say is that 99 times out of a
hundred rectal bleeding is an innocent manifestation of benign conditions
such haemorrhoids and others. Since haemorrhoids are very common most
people have seen at least once in their life rectal bleeding but they are
otherwise in perfect health.
Is there a way to distinguish whether rectal bleeding comes from
haemorrhoids or from some more sinister cause such as polyps or cancer? A
lot of effort has gone into answering this question and the short answer is, no
there is no way to be certain.
Some features of bleeding are considered more likely to be causedby
haemorrhoids, such as bright red blood which drips at the beginning or the
end of the bowel motion, is not mixed with the stools and is related to anal
pain or irritation.
On the contrary dark blood, passing clots, blood mixed with the stools or
mixed with mucous is more suspicious for cancer, colitis and infectious
diseases.
To ascertain the source of bleeding an examination is required in the form of
proctoscopy, sigmoidoscopy, colonoscopy.
Change of bowel habits is considered suspicious only of it persists for
several weeks and is unexplained. Also change to increased frequency or
diarrhoea is more suspicious than constipation for cancer.
Diarrhoea has been experienced by everyone and it is commonly caused by
reaction to foods, food poisoning, infections, inflammatory bowel disease and
many enteropathies such as coeliac disease etc. Investigation of diarrhoea
can be a complex matter which requires a specialist gastroenterologist.
Constipation which sets in gradually with increasing age is rarely
suspicious. Acute constipation which is established over a period of a few
weeks may be caused by an obstructing tumour. Constipation appearing in
women after childbirth is sometimes related to pelvic floor problems such as
rectocele, obstructive defaecation syndrome, rectal prolapse etc.
Tenesmus is a feeling of something present in the rectum causing a feeling
of irritation and the need to go the toilet. It can often be the result of benign
disease such as prolapse however tumours may also cause it.
Passing mucous is normal, particularly if there is irritable bowel syndrome.
However the quantities should normally be small, if sudden large discharge of
mucous sets in then sometimes a villous adenoma of the rectum may be
present.
Acute severe anal pain can be caused by anal fissure. If associated with
swelling and bleeding it can be due to haemorrhoids.
Severe anal pain with swelling, a hot lump, fever and discharge of pus
indicates a perianal abscess.
Abdominal pain can be caused by a myriad of conditions and several
investigations are required.
Abdominal distension is often caused by gas, as in irritable bowel
syndrome, constipation or just obesity. Much more rarely it can be caused by
expanding abdominal tumours, bowel obstruction or ascites.
Iron deficiency anemia is sometimes caused by loss of blood from the
bowel. The cause may be a bowel tumour that's why usually there is an
indication for a colonoscopy.