01 April 2017
Q: I have noticed a couple of episodes of blood on the toilet paper and my bowel habits are not as regular as they were before. Should I be worried?
A: There could be a variety of reasons for such symptoms ranging from very benign conditions like haemorrhoids and irritable bowel syndrome (IBS), to more serious conditions like polyps and cancer.
Not everyone has a regular bowel habit, however, if your bowel habits change for any reason and the changes persist for more than 4 weeks you should consult a doctor and have some baseline tests done. A change in your bowel habits could be; getting constipated or going loose and frequently. Mucus (white frothy stuff) in your stool and a degree of urgency when one has to rush to the toilet are more worrying symptoms.
Blood after the stool may be seen on the paper or dripping in the pan. If there is a severe pain in the perineal area at the time of bleeding it could suggest a “fissure” - a crack in the lining of the back passage, which is easily treatable with the right medications. Bright red blood and dripping in the pan without any pain are features suggestive of haemorrhoids, most commonly known as piles.
A local examination can easily identify any piles in the area, though the best test in these situations is a flexible sigmoidoscopy. This is also known as a telescope test where a fibre-optic camera is passed through the back passage in order to examine the rectum and left colon. The procedure takes 10-15 minutes, is pain free and can be done as a day case. It is however, advisable to perform an enema to clean the lower bowel before the examination. This test can assess the piles, check for any polyps or cancers and any other condition affecting the bowel like diverticular disease.
The most effective treatment for piles today is the Doppler-guided ligation where specialised equipment is used to cut off the blood supply of piles and no tissue has to be excised, making it a relatively painless day case procedure associated with a very quick recovery. The treatment has been available at Spire Portsmouth hospital for nearly 5 years.
Only 1 in 10 people who have bleeding from the back passage will have a more serious underlying condition, however, an endoscopy would have to be performed in order to determine the cause of bleeding. If the changes in your bowel habits persist for more than 6 weeks, you get intermittent rectal bleeding, lose weight for no obvious reason, are found to be anaemic or have a strong family history - I would highly recommend you contact your GP or a specialist in bowel diseases.
The most recent NHS figures show bowel cancer claims the lives of around 16,000 people in the UK every year and is the second most common cause of cancer death in the UK.
Mr Jim Khan is a Consultant Colorectal Surgeon practising at Spire Portsmouth Hospital.
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.