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Five Questions with Antonina Mikocka-Walus, author of IBD and the Gut-Brain Connection

What was the inspiration behind your book?

As a scientist interested in the gut-brain links in IBD, I collect articles on the topic. There are hundreds of them scattered around my various computer drives. One particularly rainy summer, when I still lived in York, I thought I should organise these articles and collate my scribbled notes into something meaningful, so that I could use it for my future papers. However, this organisational task proved more entertaining than I initially predicted. I found some fascinating studies I forgot about, and as I read on I thought: There is so much out there. It must be hard to make sense of it when one is a patient. Many of the papers also triggered some memories from my own experience as an IBD patient, negotiating my way through the healthcare systems of the three countries in which I have lived. That’s how the book came about, though until it was finished I considered it merely my personal diary, a collection of interesting studies and anecdotes. I then showed this manuscript to a friend, another IBD psychologist, who enjoyed reading it and encouraged me to publish it. And the rest, as they say, is history.

What was the most challenging part of writing the book?

It was to move away from scientific writing, to make what I write interesting and accessible to a lay person, but also, more importantly, sharing my life story. I do not hide that I have IBD but in this book I go beyond merely admitting I am a patient as well as a health professional. I discuss my symptoms and recall a bit of my family history. I believe these snippets from my own life make the story I tell more real but as is the case when one chooses to share their private matters with the whole world I feel vulnerable, and that’s not always pleasant.

What has been the most satisfying part of the writing process?

The most difficult part – sharing my life stories – was also the most fulfilling. When I decided this manuscript would become a book, I wanted to make it different to a book about IBD written by a health professional. But I also wanted to offer my readers more than my own stories, to go beyond ‘Me and my IBD’ narrative. I reached to what I love, science, and I merged interesting science findings about IBD with something personal. I hope I found a happy compromise in combining the perspectives of a patient, psychologist and scientist.

Did anything surprise you while writing IBD and the Gut-Brain Connection? 

Not the science itself because that’s my daily bread but the amount of the data, the presence of mutually exclusive recommendations. I followed the principles of evidence-based medicine to interpret what I read for the readers without a medical background. But nothing, even in science, is completely objective. I introduced the readers to systematic reviews, a scientific technique to try to make sense of the many studies out there and being critical about the evidence which surrounds us. I hope people find this technique of filtering evidence useful. On the other hand, I decided to also include my completely subjective perspective on IBD when I shared my own stories. The truth is somewhere on the verge of science and a personal human experience, I think.

What sort of people would benefit most by reading your book?

The book is addressed to patients living with IBD, their family and friends, to people of all ages and educational backgrounds, to anyone who wants to learn more about this fascinating condition. The brain-gut links and the gut bacteria have finally become topical and I feel really privileged to be able to speak openly about the gut health. Who would dare to discuss bowel movements publicly a few generations ago? Now, it’s becoming normal and I am happy to be part of this social revolution.

If you would like to learn more about IBD and the Gut-Brain Connection, the first chapter of Antonina’s book is available to read here

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Inflammatory Bowel Disease: The invisible illness

Inflammatory-Bowel-Disease-The-Invisible-Illness

What is inflammatory bowel disease?

Inflammatory bowel disease (IBD) is an umbrella term for diseases which cause either whole or part of the digestive tract to become sore and inflamed. It commonly starts in younger people aged 10 to 40, although younger and older people may be affected too. The two most common types of IBD are Crohn’s disease (CD) and ulcerative colitis (UC); the symptoms for both can be similar but with some distinguishing characteristics. In the 19th and 20th Centuries prevalence of IBD increased with industrialisation and the highest rates in the world are still in developed countries such as the UK, Canada, the USA and Western Europe – although cases are now increasing in China and India.
Crohn’s disease may affect the whole digestive tract from your mouth to your anus; ulcerative colitis affects only the colon. Crohn’s disease can be more serious as it not only affects the lining of the gut but can also extend deeper into the wall of the bowel and this sometimes results in severe complications. Both can be extremely painful and debilitating, leading to weight loss and fatigue, and have a great impact on your quality of life, affecting your ability to digest food and absorb nutrients from it, as well as the frequent trips to the toilet.

Why is IBD increasing?

Studies in the UK have found that the number of children affected by IBD has risen by 15%; in Scotland the number of childhood cases has risen by 76% since 1995, according to research by the University of Edinburgh. Experts are also worried because the average age of onset of symptoms is now much earlier in childhood rather than late teens/early 20s because, as I said before, the symptoms are more severe in childhood.
Although scientists have identified a genetic basis for IBD by pinpointing many different genes, especially the variants in a gene called NOD2 in Crohn’s disease – and a positive family history remains the strongest risk factor for IBD4 – genes are clearly not the whole story. Experts refer to IBD ‘as a complex genetic disorder that is influenced by environmental risk factors’. Certain genes may give you a susceptibility to IBD, but the prevailing theory is that IBD is caused by a combination of genes and exposure to environmental risk factors. It’s the interaction between these environmental risk factors and your normal (nonharmful) gut flora that is believed to lead to an increased immune response which results in chronic inflammation.

What are the symptoms of Crohn’s disease compared to ulcerative colitis?

The short answer is that many of the symptoms overlap (around 10% of IBD sufferers have a mixture of both and this is called indeterminate colitis). There are some key distinguishing characteristics your doctors will be able to tease out – see the table below.

Ulcerative colitis (just affects the colon) Crohn’s disease (can affect the whole gut)
Bloody diarrhoea and colicky abdominal pain, usually before passing a stool Abdominal pain and diarrhoea (sometimes with blood, pus or mucus). Pain is caused when food or faeces build up after eating in an area of the intestine damaged/ narrowed by inflammation
Some of or the whole colon is inflamed/ ulcerated, but other parts of the gut are usually unaffected Patches of the gut are inflamed and ulcers may develop but there are sections that are unaffected. It mainly affects the terminal ileum (the last part of the small intestine). Sometimes Crohn’s only affects the colon
Only affects the lining of the gut Inflammation may be confined to the bowel wall but can sometimes cause deep ulcers which also penetrate deeper through the muscle layers of the bowel wall causing fistulas (an abnormal connection between one area of the body and another). Often these are around the anus. Other complications include scarring and narrowing of the intestines, sometimes leading to blockages
Inflammation is usually continuous from the rectum Inflammation often skips segments of bowel which appear normal
 
Weight loss from inflammation

Weight loss from inflammation and reduced absorption
Tiredness and fatigue (anaemia is common) Tiredness and severe fatigue (anaemia and other deficiencies occur)
Feeling feverish Sometimes fever and night sweats can be caused by abscesses or collections of inflammation
Inflammation can involve the joints, skin, liver and eyes and cause mouth ulcers Inflammatory symptoms are similar to those of UC and may spread to other parts of the body causing mouth ulcers, red eyes, painful joints and rashes

Sources: Core charity and Crohn’s & Colitis UK

More about Crohn’s disease

Crohn’s disease affects around one in 1,000 people and in about one in five cases if you have Crohn’s disease you will have a family member who is also affected.

As discussed in the table above, Crohn’s disease may affect any part of the gut but most commonly causes inflammation in one particular area called the terminal ileum – this is the last section of the small intestine. The first part of the colon, called the caecum and the next, the ascending colon, are often involved. In many people only the colon is affected. Inflammation sometimes skips a segment of gut which is normal, rather than being continuous. Only a few people with Crohn’s will have involvement of the stomach or the upper intestine.
Mild forms of Crohn’s result in patches of inflammation – these look similar to mouth ulcers. In moderate to severe cases the intestine is damaged, and becomes thickened so it blocks the passage of digested food, causing cramp-like pain. Deep ulcers can also penetrate the bowel wall causing infection or even an abscess; this often happens around the anus. It is called a fistula when an inflammatory connection goes through the skin surface, the vagina, the bladder or another part of the bowel. When inflamed tissue heals, scar tissue may form, posing a further risk of blockages in the bowel.

More about ulcerative colitis

Ulcerative colitis is the medical name for when tiny ulcers form on the surface of the lining of the large intestine. It mainly affects the rectum and lower colon, but may affect the whole of the colon. It’s more common than Crohn’s disease, affecting an estimated one in 420 people. It seems to be more common in white people of European descent, particularly among Ashkenazi Jews who originated from Eastern Europe and Russia. It affects non-smokers and ex-smokers more than smokers, although doctors say the risks of smoking still far outweigh the possible benefits so do not take this as a licence to smoke! Men and women are affected by UC in equal numbers.

There are three types of ulcerative colitis:

  • Proctitis. This is where only the rectum is inflamed. Fresh blood in the stools is the main symptom, plus an urgent need for the loo (‘urgency’) and perhaps a feeling that you have not completely emptied your bowels. You may have normal stools, diarrhoea or constipation.
  • Left sided. This is inflammation that starts at the rectum and continues up the left side of the large intestine (the sigmoid and descending colon). Symptoms include passing diarrhoea with blood and pain on the left side of the abdomen, plus an urge to pass a stool even when your bowel is empty.
  • Total colitis. This is sometimes called pan colitis and is when the entire colon is affected to some extent. It causes very frequent bouts of diarrhoea, severe painful stomach cramps, weight loss and often fever and generalised illness.

This extract was taken from What’s Up with your Gut? By Jo Waters and Professor Julian Waters

 

 

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How to cope with IBD at work

How to cope with IBD at work

Sometimes it seems that living with IBD is a full-time job (albeit one with zero pay or benefits!). Time spent at the hospital, recovering from flares and trying to live a healthy life can all add up. Unfortunately, most of us are not millionaires and work is a necessity, and for lots of us a fulfilling part of our lives. Working with IBD isn’t always easy but for the vast majority of us it is possible. However, you may need to talk to your employer and have adaptions made.

 

Be honest

It is very important that you are honest with your employer about your condition and what it involves. IBD, like any chronic illness, is covered under the 2010 Equality Act since it is a physical and long-term impairment (definition of disability under the Equality Act 2010, 2015). This means employers must make necessary adaptions to help you in your role. This could include flexible working hours, access to a disabled toilet or a fridge to store your medicine in. Most employers are accommodating if you talk to them and explain what your condition actually entails (and if this is disclosed at interview, employers cannot discriminate against you in the recruitment process).

 

Be realistic

Many people with inflammatory bowel disease have really high expectations of themselves, which is also reflected in their careers. However, it is important to reflect on your career path and whether it is adaptable to life with IBD. Does it involve lots of travel? Is it stressful? Are you often on the go? Having IBD doesn’t mean giving up on your career dreams but just making sure the job is right for you.

 

Be informed

Reading the paperwork and the terms and conditions that comes with a job is more important than ever with IBD. Here are some things you need to find out:

  • What is the sick pay entitlement?
  • What is the policy for long-term periods of sickness?
  • How flexible are the working hours?
  • If you are working abroad, is medical insurance included and does this include pre-existing conditions?
  • Will you get regular breaks? (This can be easy for office workers; not so easy for those in retail.)
  • Is there the possibility of reduced hours or going part-time further down the line?

Keep records

It may be worth having a notebook to keep a list of any time you have had to take off work for IBD and the corresponding symptoms and hospital trips.

 

My experience of working with IBD

I am a teacher by trade and have taught both in the UK and abroad. In every job, I’ve been honest about my conditions from day one and luckily all my employers have been great. When I was on infliximab, my employers were great at giving me time off to go to hospital appointments and in my previous role I had surgery and the school arranged for me to come back on a phased return. It can be really hard teaching with IBD – I have had days where I felt like I wanted to faint in front of a class – but luckily most of the time I’m fine. In some ways doing a demanding job means I often forget about my symptoms, but I have had to dash out of class on a few occasions. I think this is why talking with colleagues about your condition is so important – it has meant they have been able to quickly step in if needed. Yet over the years, I think I’ve also become more realistic about my teaching career and this year I’ve reduced my workload to three days a week, aiming to spend more time on my health and my writing. I don’t see this as a step down but a necessary adaption to help me live as balanced a life as possible; hopefully I can combine the security of a teaching job with my other passions in life – writing and nutrition.

This blog is taken from Managing IBD: A balanced guide to inflammatory bowel disease by Jenna Farmer.

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Taking charge of anxiety with an invisible illness

Mental health and coping with anxiety affects everyone, and if you are suffering from an invisible illness it can be even more difficult. It’s #mentalhealthweek so here are some tools for looking after your emotional and mental health when dealing with chronic illness, whether it be IBD, IBS, CFS, ME or other fatigue/auto-immune conditions.

How can we deal with anxiety and invisible illness?

Since many patients feel stress can trigger their symptoms, it is vital to try to get a handle on anxiety. It has been suggested that support for this should be part of Inflammatory Bowel Disease (IBD) patients’ care plans, yet currently only 12 per cent of IBD clinics offer this. Therefore, it is clearly an area where more medical services need to be directed. As I discussed in Chapter 1, initial consultations after being diagnosed can lead to the patient being overwhelmed with information and having a variety of leaflets thrust into their hands about the disease they can only take in later. But where’s the leaflet that tells us how to cope with the associated emotions? The leaflet that gives us ways of not breaking down, and staying strong? The leaflet that offers support groups and websites?

Hopefully the studies I have cited have highlighted the growing link between mental health and IBD. Of course, if you feel you are struggling with anxiety and depression it is vital you speak to your GP urgently. If you have done this and are looking for some self-help suggestions to deal with times of worry and help manage your anxiety, then the guidance below from Sally Baker – a therapist who works specifically with the mind-body connection – may be beneficial. (It is important to be aware at the same time that these tips offer general guidance which cannot replace the individual advice of a medical professional and if you are feeling any new symptoms of anxiety and depression, then it is very important to see your GP.)

Advice from Sally

When Sally works with clients living with chronic ill-health she recognises how having little or no confidence in how one will physically feel from day to day encourages self-doubt and frustration. As you are probably aware, feeling negative about yourself can create a vicious circle of frustration, disappointment and anger. One of the first therapeutic approaches she suggests to break this cycle of negative self-thinking is to encourage patients to gain an enhanced level of self-awareness to highlight the impact those uncomfortable emotions have on them.

She has found one of the most beneficial ways of discovering if a person is prone to negative thoughts about themselves is to explore the kind of things their inner voice says to them. If on reading this your response is, ‘What inner voice? – I don’t have one!’ then that is your inner voice.

Your inner voice runs an almost continuous internal dialogue commenting on everything you do and often makes judgements on how well you do it too. Happening as it does just below conscious awareness, one’s inner voice goes unchecked, and unchallenged, for most of the time.

For many people, especially those living with chronic illness, their inner voice is rarely a source of uplifting encouragement. It is more likely to give an unremitting flow of self-criticism, and negative self-judgements (everything from ‘I hate my body’ to ‘What am I doing wrong?’). Taking the time to become aware of how your inner voice speaks to you can accurately demonstrate to you your own level of self-judgement and self-condemnation. Tuning in, and clearly hearing your inner voice, is the crucial first step to silencing the draining and dispiriting stream of negativity that can hinder moving forward and making positive changes. Sally suggests spending a little quiet time – just a few moments – every day for about a week tuning in to your inner voice, and simply listening and noting down the negative statements. A therapy tool she then uses to resolve those negative, limiting beliefs is called Emotional Freedom Technique (EFT or ‘Tapping’). EFT is an energy therapy that has proved highly effective for revealing true feelings, in this case prompted by one’s negative self-talk.

Once you have a greater awareness of your own negative self-talk you can then apply another of her core therapy tools – called Percussive Suggestion Technique (PSTEC) – to turn-down, or dispel, the emotions attached to the negative beliefs you have about yourself. Turning off negative self-talk is the beginning of a powerful journey which can transform a former inner-critic into your greatest advocate – someone cheering for you instead of undermining you.

This blog is taken from Managing IBD: A balanced guide to inflammatory bowel disease by Jenna Farmer, available as ebook and paperback. For more from Jenna you can follow her blog A Balanced Belly, and for more emotional therapy techniques from Sally Baker check out her book Seven Simple Steps to Stop Emotional Eating.

If you found these tools helpful help us raise awareness of mental health by sharing for #mentalhealthweek

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Is it ‘just’ indigestion?

Indigestion is that uncomfortable feeling most of us have experienced at some point in the upper abdomen or lower part of the chest – usually after eating or drinking (but not always). The official medical definition is upper abdominal discomfort or pain that may be described as a burning sensation, heaviness or an ache. It is often related to eating and may be accompanied by other symptoms, such as nausea, fullness in the upper abdomen or belching. It’s usually worse if you lie down directly after eating a heavy meal.

Other names for indigestion include dyspepsia and acid reflux or heartburn. It is basically an inflammation of the gullet (oesophagus) – the long pipe that runs from the mouth to the stomach. Indigestion is so common most people will have experienced it at some time and it’s usually more of a fleeting inconvenience than a major health problem. Most people don’t see their doctor about it and either grin and bear it or simply treat it themselves with remedies they can buy over the counter from a chemist. Only a quarter of people who suffer indigestion see their GP about their symptoms and about 10 per cent of these consultations will be referred for further investigations.

Indigestion is rarely a symptom of a serious underlying medical condition (but if you are worried check out our list of reasons for an urgent referral, below). In people who have an endoscopy to investigate their indigestion, 30 per cent will have no abnormal findings and 10 to 17 per cent will have oesophagitis (inflammation of the oesophagus) and the rest will have gastric or duodenal ulcers, gastritis, duodenitis (inflammation of the duodenum) or hiatus hernias, according to the British Society of Gastroenterology.

But, having said that, we’re not saying indigestion can’t still affect your quality of life and be a pain to deal with. If you’re one of the unfortunate ones who suffer from recurrent severe bouts of indigestion, Chapter 8 in What’s Up With Your Gut may help you get to the root of what’s causing your symptoms, help you find some long term relief and enable you to enjoy your food again.

Symptom Checker

If you have one or more of the following symptoms, you may have one of the conditions discussed in this blog.

  • Burning sensation, fullness, heaviness or ache in upper abdomen or lower chest
  • Burning, griping pain in the abdomen, lower gut and back
  • Sharp, persistent pain at the top of the stomach or above ribs on right
  • Bitter taste in the mouth
  • Nausea, vomiting
  • Bloating
  • Belching and burping
  • Lump in your throat
  • Tickly cough

What causes indigestion?

Diet

Most people associate indigestion with overdoing it, with a big meal, sometimes with a high fat or spice content – creamy curry sauces and dishes containing chilli for instance. You might also notice that particular foods can trigger your symptoms, including curries, fatty foods, citrus fruits, bananas and cucumbers – it’s very individual though. Sometimes however, it can be down to something simple such as eating too fast or too close to bedtime. Drinking too much alcohol, or caffeine in coffee, tea and chocolate may have a similar effect.

Drug side effects

There are many other causes of indigestion and sometimes the cause isn’t so obvious. These other causes include the side effects of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) taken to relieve the pain of arthritis (such as ibuprofen and aspirin) and nitrates prescribed for angina for instance.

Acid reflux or GORD

A major cause of recurring indigestion is acid reflux, or gastro-oesophageal reflux disease (GORD), which is caused by the sphincter in the oesophagus failing to close and prevent

large amounts of stomach contents, including acid, moving back up from the stomach and causing irritation and inflammation in the oesophagus. The inside of the oesophagus has a protective lining but it can become irritated and inflamed by stomach acid. If the lining becomes ulcerated by the stomach acid, it causes a condition called oesophagitis. Sometimes stomach acid can escape back up from the stomach to the oesophagus due to gastric and duodenal ulcers (known collectively as peptic ulcers), which are sores which develop in the lining of the stomach or duodenum. Peptic ulcers can be caused by a bacterial infection called Helicobacter pylori.

Another cause of GORD is hiatus hernia – where part of the stomach pushes up through the diaphragm (the sheet of muscle between the abdomen and the chest, needed for breathing), partially blocking refluxed stomach acid in the oesophagus. Being overweight or obese (including weight gain due to pregnancy) will make it more likely you’ll suffer from acid reflux – obesity causes more pressure in the abdomen which forces acid back up into the gullet. This is also true if you are constipated or wearing clothes with a tight waistband. Chemicals in cigarette smoke can also relax the ring of muscle that divides the stomach from the oesophagus and make it easier for stomach acid to escape back into the gullet, causing acid reflux/heartburn symptoms. Stress and anxiety are also believed to play a part in indigestion, as is increasing age.

If you have some of the ‘alarm bell’ symptoms described below you should be considered for urgent endoscopy referral rather than taking any prolonged treatments which may mask the symptoms of a more serious illness.

Reasons for an urgent referral

NICE advises that:

  • people with an upper abdominal mass require urgent referral for endoscopic investigation (an appointment within two weeks) [National Collaborating Centre for Cancer, 2015].
  • urgent direct access upper gastrointestinal endoscopy should be performed within two weeks to assess for stomach cancer in people with dysphagia (swallowing problems) or aged 55 and over with weight loss and any of the following: upper abdominal pain, reflux, dyspepsia.
  • referral for non-urgent direct access upper gastrointestinal endoscopy should be considered to assess for stomach cancer in people with haematemesis (vomiting blood) and in people aged 55 or over with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain; or nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain [National Collaborating Centre for Cancer, 2015].

If you’re struggling with indigestion don’t panic, but don’t let it ruin your life. If you have any doubts at all about whether your indigestion might be something more serious, visit your doctor and tell them ALL the symptoms.

What’s Up With Your Gut is available now as paperback and ebook.

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How to work out what’s wrong with your bowel

Apart from the red flag symptoms listed in the previous blog, where do you start when trying to work out what’s up with your gut?

You can help yourself and your doctor by:

Keeping a diary of your symptoms.

It helps your doctor make a diagnosis if you can be specific about how long you’ve had your symptoms, what they are, what seems to trigger them or whether they are present all the time, and how much weight you have lost. Keeping a diary of your gut symptoms will help you remember and give your doctor valuable information. One gastroenterologist has told how increasingly patients will photograph or video their bloated stomachs on their mobile phones to document their symptoms.

Not being embarrassed.

People literally die of embarrassment because they can’t get their heads round describing their stools/piles/diarrhoea to their doctors. Get over it. If you don’t like describing what your poo looks like ask your doctor if you can point it out on the Bristol Stool Chart.

Mentioning any family history of gut disease to your doctor.

Some complaints do have a genetic basis so it will be another piece in the jigsaw for your doctor if you can supply details of conditions such as bowel cancer or inflammatory bowel diseases in your immediate family. (Volunteer this if they don’t ask you first.)

Not cutting out food groups on a hunch.

If you do have an autoimmune condition, such as coeliac disease, where the body reacts to gluten and causes bowel symptoms, it’s important you don’t cut out any foods you suspect are to blame, such as bread or breakfast cereals, until your condition has been fully investigated. This is because you may need a gut biopsy to confirm your diagnosis (the villi – fingerlike projections in the gut which absorb nutrients – will be damaged and shrunken if you have coeliac disease) and if you have stopped eating gluten they may have returned to normal, giving a false negative diagnosis.

Being persistent.

If your doctor has told you to eat more bran to help with constipation and your symptoms are getting worse, go back and tell him or her. Whilst eating more fibre helps in a lot of cases of constipation, in up to 30 per cent of cases it doesn’t. (The cause could be slow transit in the gut, in which case too much fibre will make it worse!)

Not self-medicating for the long term.

Obviously it’s fine to buy over-the-counter remedies if your gut problems are short term, but if you are relying on laxatives, antacids or anti-diarrhoea medication in the long term it’s advisable to see a doctor and find out the underlying cause.

Finding reliable sources of information.

There are an awful lot of ‘snake oil’ salesmen out there on the internet, peddling dodgy cures or extreme diets with no good science to recommend them. Charities are good sources of accurate information about managing your condition and their online resources are written in a reader-friendly consumer style. Don’t forget organisations such as NICE (the National Institute for Health and Care Excellence) produce guideline summaries on the management of health conditions written especially for patients, setting out clearly what investigations and treatments are recommended.

For more information and advice on how to manage difficult bowel symptoms and improve gut health problems such as IBS and IBD, read What’s Up With Your Gut, out now.

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Recognising red flags when suffering from bowel problems

There are some gut symptoms associated with bowel problems you should never ignore and we thought it best to flag them up here – if you are think these symptoms may apply to you talk to your doctor. Chances are it’s nothing to worry about, but better safe than sorry.

New symptoms

A lot of people endure symptoms such as pain, alternating bowel habits and food intolerance. These may have gone on for a long time, fluctuating in intensity and are sometimes helped by one or two dietary changes, and sometimes not. But recent changes are likely to be more serious than something that has persisted for years. If you had similar problems in your 20s to those in your 50s  and in between), it is unfortunate that you may have had to wait so long to get any answers, but it is not likely to be a life-threatening condition. If the symptoms have just started, it is far more worrying.

Don’t be embarrassed. Help your GP assess what needs to be done. Be sure to describe how long you have had the symptoms and explain exactly what you mean. In particular, be sure to tell your GP about the following symptoms as they may indicate a serious condition:

  • abdominal pain and fever
  • anaemia
  • blood in your stools
  • change in bowel habits
  • jaundice and definite lumps you can feel
  • unexplained weight loss.

Abdominal pain and fever

Fever and sharp, stabbing abdominal pain can have several causes and you may need to go to A&E or even call an ambulance if these are severe and sudden in onset.

Anaemia

Anaemia, which will make you look pale and feel tired, may be due to hidden (‘occult’) blood loss, and your GP may organise for you to have an endoscopy and/or colonoscopy, together with blood tests for coeliac disease, iron, B12 and folate deficiency.

Blood in your stools

Blood in your stools must be investigated. If it occurs only on wiping the anus with toilet tissue, it may just be haemorrhoids (piles) or an anal fissure (tear), but this should be checked by an examination, and then perhaps by a limited flexible sigmoidoscopy. If there is blood mixed in with the stools, you should be referred to a gastroenterologist or colorectal surgeon and have further tests, such as colonoscopy (or possibly a CT scan), to be certain bowel cancer and ulcerative colitis have been excluded. These are major diseases which are much more successfully treated if caught early and are not difficult to diagnose with the proper tests, so get your GP to refer you to a gastroenterologist if you suspect one of these. Although bowel cancer increases in likelihood as you get older, it is common enough that people aged 40 to 50 or younger can get it. If you know that you have a family history of bowel cancer you are also more at risk. The good news is that, when you have had a colonoscopy, you can be sure for quite a long time (several years) that this has been excluded as the cause of your symptoms. The faecal calprotectin test is now also useful in predicting if you do need a colonoscopy. If you are older, be sure to get the routine screening tests that are now offered.

Change in bowel habits

If you have a recent change in your bowel habit, then tell your GP and be prepared to get more tests. Clearly, if everyone in your family has just got the same symptoms after eating the same food, or you have just come back from an area where gastroenteritis is common, and the symptoms are not too bad, you can wait a week or two to see whether things go back to normal. But if they do not, and particularly if there is blood in the stools, then you MUST get tests.

Jaundice and definite lumps you can feel

Jaundice symptoms (yellow eyes and skin) and definite lumps, particularly if they are tender, must not be ignored. The lumps may turn out to be only hard faeces but you want to be sure that a definite diagnosis is made in case it might be an inflamed gall bladder, an ovarian or another cyst, or possibly a stomach or bowel tumour. Hernias in the groin or in other places in the abdomen may also feel like painful lumps and can also cause problems until they are treated.

Unexplained weight loss

Unexplained weight loss is important and will lead to other blood tests and probably hospital referral. Sometimes there is a gut disease (coeliac disease or Crohn’s disease, for instance) or cancer, but in other cases can be due to an endocrine disorder, such as an over-active thyroid, or to a wide range of other disorders, including neurological or mental health problems (you cannot buy, cook or chew your food), or cannot easily eat (dental problems, for instance or Alzheimer’s). These should be fairly easy for your GP to diagnose.

It can be very hard to start figuring out what’s up with your gut, so listen to your body and be aware of any possible symptoms that you should tell a doctor or other health professional who may be able to help. For less serious conditions, just keeping track of how you feel can help you to improve your symptoms on your own.

For more advice on how to track your symptoms and get to the bottom of your bowel issues read our next blog: Working out what’s wrong with your bowel, and order your copy of What’s Up With Your Gut? by Jo Waters and Professor Julian Walters.