Difficult to discuss

01 July 2016

Tony Miles, a Consultant General Surgeon who specialises in colorectal surgery, talks about a problem many people find difficult to discuss.

I’ve had some rectal bleeding, what should I do?

Rectal bleeding is one of the most common complaints that comes into my clinic. For most people rectal bleeding is innocent, nothing more than haemorrhoids. Unfortunately in a small number of patients it can indicate something more. The thing to remember is that the investigations for rectal bleeding, whilst a bit embarrassing and a little bit uncomfortable, are very safe. It’s much “safer” to be investigated than leave things and take a risk.

  • If you are under 40 a flexible sigmoidoscopy (passing a small flexible telescope through the rectum into the lower third of the colon) is often done to be sure that there are no problems.
  • In patients over 40 with rectal bleeding and a change more frequent stool a full colonoscopy (inspecting the whole colon) is usually performed- although some surgeons prefer just to do a flexible sigmoidoscopy.
  • Patients over 60 with either bleeding or a change to a looser stool for more than 2 weeks should have either a colonoscopy or, if that is not possible, a CT cologram. Patients with unexplained abdominal pain or a lump to feel in the abdomen should have a CT.
  • Finally, patients who have unexplained anaemia should be investigated by a camera passed in to the stomach and the colon.

Is the risk the same for all age groups?

No. The risks, in terms of cancer, are much lower in young people, although young people can have other problems such as colitis or fissures. Colon cancer is very rare in people under 40 and rare in people between 40 and 60. From 60 onwards it becomes more common.

What about screening for bowel cancer?

Colonoscopy is the most effective method of detecting colon cancer, but it is not practical to colonoscope everybody. The government has decided to offer everybody a single Flexible Sigmoidoscopy when they are 55. This is a simple investigation undertaken with minimal preparation; it takes about 10 minutes and does not need any sedation. A full colonoscopy however has been shown to be more effective in reducing overall risk. The government also offers stool testing from age 60,- this can indicate those people who are at higher risk of developing cancer and so should have a colonoscopy. The government screening program can reduce your risk by about 20%. More intense screening involving regular colonoscopy, flexible sigmoidoscopy and stool testing can reduce risk by up to 80%.

Tony Miles, a Consultant General Surgeon offers private consultations at The Montefiore Hospital, Hove. Mr Miles specialises in colorectal surgery. To book an appointment, call 01273 828 148 or email montefioreinfo@spirehealthcare.com.

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.

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