Ignoring piles can just pile on problems: As doctors say too many of us are embarrassed to seek help, one mother's very cautionary story
01:10 GMT, 12 June 2012
Like many people, Linda Gunner didn’t enjoy visiting the doctor — but was particularly reluctant to seek help for piles.
The mother-of-two had been suffering from piles, also known as haemorrhoids, for almost a year, and although her doctor had told her to go back to her if the symptoms didn’t improve, she was too embarrassed.
‘It started off as a niggling problem — I’d had piles in the past during my two pregnancies, but in the previous 12 months they’d become more serious.’
Doctors are concerned that too often people dismiss rectal bleeding or blood in the stools as just a symptom of their piles, and don't get it investigated
The condition, which causes swollen blood vessels around the back passage, triggering pain and bleeding, affects up to one in four of us at some point in our life.
But doctors are concerned that too often people dismiss rectal bleeding or blood in the stools as just a symptom of their piles, and don’t get it investigated.
The worry is that the bleeding could actually be a sign of bowel cancer.
Indeed, Linda, a 58-year-old legal secretary who lives with husband Steven, 58, a stonemason and their two daughters Emma, 25 and Sophie, 22, in Southminster, Essex, assumed her symptoms were simply her piles flaring up.
She used more cream to shrink the swollen blood vessels, and ate fibre such as Weetabix and wholemeal bread, as this is known to ease the symptoms by reducing the need to strain.
Her symptoms eased slightly and although they never disappeared completely Linda had no reason to suspect it was anything sinister.
But in October last year, nearly a year after her GP diagnosed piles, Linda was rushed to hospital.
‘I had noticed bleeding earlier in the evening but thought it would stop,’ she says.
‘But at 4am I woke up and realised I’d lost a lot of blood. Steve took me straight to A&E.’
Although initially Linda was told it was possibly due to one of the piles bursting, one doctor said he could feel a growth in her rectum, and advised further tests.
Embarrassment is a significant barrier to people seeking help for any rectal bleeding
She was booked in for a flexible sigmoidoscopy a few weeks later where a camera attached to a flexible tube is inserted through the rectum into the left side of the bowel — where statistically most cancers are found.
‘They asked if I wanted to watch the procedure on a TV screen, but I couldn’t bear to look. I thought it was disgusting,’ says Linda.
Tests revealed a cancerous growth in her bowel.
‘I burst into tears — I couldn’t believe it as I’d had no pain or unusual bowel symptoms and certainly hadn’t lost any weight or felt tired. I kept thinking they must have got it wrong as I felt so normal.’
Bowel cancer, also called colorectal cancer, causes around 16,250 deaths a year.
There are around 40,000 new cases annually and although the five-year survival rate is now 95 per cent if cancers are detected in the bowel at the earliest stage, this drops to six per cent for advanced cancers, and too many early cancers are being missed.
Symptoms include blood in stools, bleeding from the bottom, unexplained weight loss, extreme tiredness for no obvious reason, a change in bowel habit for more than three weeks (especially loose stools) and a pain or lump in the tummy.
But it’s also possible to have bowel cancer with no symptoms at all.
And because there is some overlap with the symptoms of haemorrhoids — including bleeding when passing stools and pain — the two conditions can be confused.
Furthermore, because low-fibre diets and being overweight increase the risk of both conditions, experts say it is not uncommon for bowel cancer patients to have haemorrhoids as well.
‘All too often I’ll see patients with bowel cancer who say they’ve been experiencing bleeding for two or three years but thought it was down to haemorrhoids,’ says bowel cancer specialist Dr Sean Preston, consultant gastroenterologist and general physician at Bart’s and the London NHS Trust and the private Princess Grace Hospital.
‘The truth is both haemorrhoids and bowel cancer can cause rectal bleeding and any such bleeding should be investigated to rule out pre-cancerous polyps or bowel cancer, especially in the over-50s as most cases occur in this age group or where there is a family history of bowel cancer.’
Dr Preston says that the colour of the blood lost from the bowel can sometimes indicate whether it comes from a bowel growth, called a polyp, or haemorrhoids, but this is by no means a guarantee.
‘Although blood from piles tends to be bright red because it has a higher oxygen content (because it is closer to the outside of the body), than blood from further up the gut — both cancers and polyps can also cause bright red blood loss.
‘Darker blood tends to come from further up the colon and is not due to haemorrhoids.’
Embarrassment is a significant barrier to people seeking help for any rectal bleeding, adds Dr Preston.
‘We have to persuade patients to get over their embarrassment talking about bottoms and bowel movements — it’s a very British trait to want to avoid the subject.
‘When I see patients for the first time some can hardly look at me.
'GP colleagues say patients will talk all around the subject before they admit that they have rectal bleeding — in fact some just go home without mentioning it at all.’
And Deborah Alsina, chief executive of Bowel Cancer UK, adds that a recent survey by the charity revealed that more than a quarter of people would put off going to the doctor with a potentially serious symptom because they would be too worried about the diagnosis.
‘Bleeding from your bottom does not necessarily mean you have bowel cancer.
'However, even if you’ve had haemorrhoids, and you feel something is not right, you should visit your doctor as soon as possible,’ she advises.
Linda blames her embarrassment about discussing intimate problems for not getting her symptoms investigated sooner.
'For any other part of my body I wouldn’t have hesitated to have tests but I couldn’t bear the thought of having my bottom prodded around,’ she says.
But this delay may have had serious repercussions.
In January this year, shortly after surgery to remove the cancerous growths from her bowel, Linda was given a Positron Emission Tomography (PET) scan, which uses radioactive drugs to detect cancerous cells.
It revealed a spot on her liver which was cancerous — and there were seven more of them.
‘The doctor reassured me these could be treated with chemotherapy which I’m having at the moment. I wish I’d seen a specialist about my piles earlier — further investigations may have found my cancer.
‘If you’ve got blood in your stools, get it investigated — it’s probably just piles, but sometimes it’s something more serious.’