I am 21 years old, not smoking, have a regular diet but kind of
low on fiber and water. Recently, I noticed that I have bloody stool. There is
no constipation, but at times, there seems to be a tiny lump beside/at my anus.
There is no pain, but after bowel movement, it seems that the last part of the
colon is pushed out, an awkward feeling.
However, just in the last few days, there are slight
abdominal pains at night, although it would disappear shortly. What could the
problem be? Could it be some inflammatory bowel disease or colon cancer?
Pauline
Dear Pauline,
It would be unusual for you to have colon cancer at the age of 21.
Nevertheless, there are some rare, inherited conditions that present at a young
age such as familial adenomatous polyposis.
This condition is associated with a large number of polyps in the colon and
with the development of colon cancer. From your description, the most likely
cause of your bleeding is a hemorrhoid. You may benefit from increasing the
fiber in your diet, stool softeners and medications such as Annusol or
Preparation H.
An easy way to increase the fiber in your diet is to try a bran cereal like
FIBER ONE cereal by General Mills. It may also be helpful to soak the area in
lukewarm water for 20 minutes per night. This might shrink any swelling in the
area.
If you continue to have bleeding despite these measures, you may require
further evaluation and testing. A flexible sigmoidoscopy is a test where a tube
with a light and video camera are introduced into the rectum and advanced up the
left side of the colon. This test is helpful in looking for bleeding lesions
just above the anal canal.
Over the past 8 months I've had several occurrences where my stool has had blood in it. Each time this has lasted about three days.
I've heard that this can be a symptom of colon cancer and I thought I'd better inquire about. I've had no other symptoms and am only 20 years old. What do you think? Rick
Dear Rick,
Anal bleeding (secondary to hemorrhoids or a fissure) usually presents with bright red blood on the rectum or with blood on the toilet tissue. Blood mixed with the stool implies a higher source.
Although colon cancer is a possibility, it would be unusual for colon cancer to occur in a 20-year-old. There are, however, other possible explanations for blood mixed with the stool in younger patients (for example: inflammatory bowel disease).
You might benefit from evaluation by a gastroenterologist and a test called flexible sigmoidoscopy (a test where a tube and a light are advanced up the left side of the large intestine to see if a source of bleeding can be identified).
About a month ago, I noticed rectal bleeding but only when I moved my bowels. It went away until yesterday, then it happened again. I am not in any pain, eat regularly, use the bathroom regularly and feel completely healthy. I do not have diarrhea, nor am I constipated.
I am not gay, therefore, there is no anal activity. I
have not been injured in any way. There is no sign of blood in my boxers either.
Blood drips out like a nose bleed, but only when moving my bowels. What could be
wrong? What will the doctor do to investigate? Justin
Dear Justin,
If blood is on the surface of the stool (indicative of a lower rectal or anal process), your doctor will do a flexible sigmoidoscopy to exclude processes such as fissures, rectal poylys, hemarrhoidal bleeding.
If blood is mixed with the stool, you will require a different more extensive evaluation that will be determined by your age, other symptoms, relative risk for colon polyps/cancer. The doctor will do either a colonscopy or a flexible sigmoidoscopy and barium enema.
My doctor wants me to have a colonoscopy done because I am anemic (my hemaglobin is 9.5). I am 49 years old and have no symptoms of abnormal bleeding, etc.
My father has a history of polyps in his colon but only
after age 65. My doctor feels that we should "go looking" and says she
"doesn't want to miss a colon cancer as one could be bleeding
intermittently." I am very, very concerned about the procedure and the
discomfort. What will they do if I can't take
the pain? Judy
Dear Judy,
We must first state that we agree with your doctor's reasoning for performing a colonoscopy. Secondly, you should be aware that colonoscopy is a fairly safe procedure.
Complications occur in 1-2 cases every 2000-3000 procedures. If a polyp is removed during the procedure, bleeding or perforation occur in approximately 1.8 percent of patients.
The anesthesia used for colonoscopy is called conscious sedation. This means that you will not be totally unconscious, but will be in a twilight zone. Most patients do not remember the procedure. In fact, many patients will
wake up in the recovery room after the procedure asking the recovery room nurse, "When are we going to start the procedure?" Nevertheless, it is hard to predict what experience you will have during the procedure.
Every patient's colon is unique in its anatomic configuration, presence of scar tissue (due to previous surgery) and tolerance to instrumentation. Your gastroenterologist will probably try to give you as much medication as possible.
However, he or she will also need to monitor your respirations and vital signs. If your blood pressure or oxygen saturation drop during the procedure your doctor may need to limit the amount of sedation given.
Finally, if adequate sedation cannot be achieved to make the procedure safe and comfortable for you, your doctor will probably stop the procedure rather than risk a complication.
I am a very healthy, soon to be 30-year old male. My father passed away due to colon cancer. Now knowing I have a hereditary risk of the disease, and having learned much about it,I am now considering going through a sigmoidoscopy or a colonoscopy. I have two questions regarding this matter.
First, am I too young to be concerned about this? My father had no idea he had the disease until there was blood in his stool (he was 58 at the time). It was too late at that point. I've noticed I might have some of the symptoms he had. I often have stomach discomfort, either dull or sharp pains. It seems I go to the bathroom way too often, often with no result; Sometimes when I exercise hard, the stomach pain is excruciating. I go through stages of fatigue and having little appetite. At the risk of sounding like a hypochondriac, should
I be screened?
Second, just for information, what is the likelihood my health insurance (PPO) would cover the screening procedure?
I have gone through a lot of remorse in not being able to
help my dad out in detecting his disease early. Anyway, I would really
appreciate your advice. Thank you sincerely. Jim
Dear Jim,
In patients whose parents or siblings have had colon cancer prior to the age of 60 and who are asymptomatic, it is generally accepted to begin screening colonoscopy about ten years prior to the age of diagnosis of the index case (in your case ten years prior to your father's diagnosis; about age 48).
On the other hand, if symptoms are present, an evaluation should be performed and testing done as clinically indicated. Given the symptoms that you described, you may benefit from a sigmoidoscopy at this time.
I do not believe that any insurance company would cover a screening colonoscopy at this time, but a flexible sigmoidoscopy done for symptoms would most likely be covered. Some insurance companies will never cover screening colonoscopy for family history of colon cancer. Others will now cover screening
colonoscopy for this indication.
I am 27 years old and I have developed an anal lump I first noticed 3 months ago. There has been no pain or itching. Also, I haven't noticed blood discharge. Could this be a symptom of colon cancer? What else could have caused this? PM
Dear PM,
Your complaint is not suggestive of colon cancer. A hemorrhoid, anal tag, or anal wart are all possible explanations for your lump. Check with your physician who can perfom an examination that should reassure you.
Dear Doctor(s):
For the past few years I have been bleeding from my
rectal area after stooling. The blood, most often, comes after my stool in
drops. I also notice that a bump appears after my stool then disappears after
some time. Are these symptoms of hemorrhoid? Cancer? Can you please give me some
information in regards to how I can remedy this problem. Thank you!
Don
Dear Don,
Blood that appears on the toilet paper or on the surface of the stool is usually due to a low rectal or anal process. The most common causes of the bleeding are hemorrhoids and anal fissures, tears in the lining of the colon. Rectal trauma can also cause bleeding. For peace of mind you should see your
physician and request that he perform a flexible
sigmoidoscopy. This test will identify large hemorrhoids and fissures (if present)as well as exclude rectal polyps or cancers.
My 67-year-old grandma had a colostomy due to colon cancer in 1989. Since 1992, she has been suffering from severe dry mouth, stomach cramping and uncontrollable severe vomiting approximately every two to six weeks. She has
been to many physicians but none are familiar with colostomies.
She has been referred to specialist who told her to come in when she was having the symptoms. However, he has never been able to see her when she is sick. She has had her gall bladder checked and other tests but they find nothing.
She has tried to relate it to diet but has found no food or food groups to associate it with. Also she irrigates daily to every other day and does not get a good return and has to do it two to three times a day. She often feels very bloated. This sickness typically lasts 24-48 hours.
She has been told that she is just going to have to live
with this but none of the physicians ever see her when she is sick- she really
suffers. We are having a hard time finding anyone who knows very much about
colostomies. Please help us know what to do. Thank you.
Rikelle
Dear Rikelle:
When there is no evidence of recurrence or reappearance of the colon cancer after 5 years, the cancer is considered "cured." Obviously there is always the chance of recurrence and for that reason
surveillance is necessary.
Colostomy refers to the opening of the large bowel (the colon) onto the surface of the abdomen. There are several different kinds of colostomies, determined by the way the bowel is attached and opened onto the skin. The frequency with which patients eliminate feces through a colostomy varies from
patient to patient and depends on the kind of colostomy and how much large bowel was left in place.
Potential complications associated with colostomies include:
Local skin irritation or inflammation.
Narrowing of the opening.
Tissue damage of the bowel at the opening site due
to inadequate blood supply (ischemia).
Peristomal hernia in which the bowel
gets into the hole that exist in the wall of the abdomen, even though it is
covered by skin (this usually produces a complete or partial blockage
("obstruction") in the bowel because it is twisted or compressed).
"Internal hernia" that is also a twisting
of the bowel but inside the abdomen.
Bleeding from the bowel.
Ruptures of the bowel.
The episodes of severe abdominal pain and vomiting that you described are suggestive of partial "bowel obstructions." This could be caused by peristomal or internal hernias. When the bowel is twisted and obstructed,
typically it produces crampy pain that rapidly becomes severe. It is usually associated with vomiting that can partially relief the pain. Sometimes the obstruction resolves by itself, and the symptoms disappear completely.
Between episodes, the bowel untwists, the patient is asymptomatic and there are no abnormalities detected by X-ray. For these reasons, it is necessary for patients to be seen when they are symptomatic. If the obstruction is complete or
if the episodes of obstruction are frequent, then surgery is considered.
I am a 24-year-old mother. I have been having severe lower abdominal cramps. It all started soon after my son was born 2 years ago. I had a hemorrhoid surgery soon after he was born. Then last year I started having rectal bleeding. I went to the doctor and was told it was just hemorrhoids. At
this time I told the doctor I was having severe cramping in the lower abdomen.
She suggested I go to an Ob-Gyn. I went recently to an
endocrinologist and was told I was anemic and to go to an Ob-Gyn about the pains. So I went to an Ob-Gyn and without testing was told I had endometriosis. I was told to go on birth control. I am not so convinced this is what I have. I have now become constipated and I almost passed out last week with these cramps.
I had a bowel movement and felt a little better. I don't feel
that the doctors here are taking these cramps seriously. I feel I could have colon cancer or at least should be tested to rule it out.
I know cancer is not something to play with and I feel
alone in my worries. I think that my age keeps these doctors from even
mentioning the possibility. Help! I am very frightened!
Christina
Dear Christina,
It is unlikely that you have colon cancer as the cause of your symptoms. It is necessary, however, to undergo an investigation. You should request a barium enema to exclude disease of your colon. A flexible sigmoidoscopy is also needed.
Hopefully, the barium enema will also visualize the terminal ileum and exclude Crohn's Disease. If the terminal ileum is not seen, then you will need a small intestine series.
I am 47 years old and have a history of cancer in my family. My father and both grandfathers have died from cancer. What are the early symptoms for colon cancer? For the past 8 to 12 months I have experience the following: narrowing of the stool, constipation and diarrhea, stomach bloating with pain, feeling of pressure like I have to go to the bathroom and pain in my lower bowels and rectum. Also, I have been getting up
sometimes as many as five times a night to urinate.
I do have an appointment to have a colonscopy. Will this
be necessary? Linda
Dear Linda,
The risk of developing colon cancer is increased if you have family members who have had the disease. I am curious if any of your relatives had their cancer before the age of 50. The symptoms that you describe of constipation alternating
with diarrhea, abdominal bloating, thinner stool may represent symptoms of irritable bowel disease, but they could also be manifestations of colon tumors. It is absolutely necessary that you have a colonoscopy.
My recent colonoscopy revealed a clear, healthy bowel. However I was more uncomfortable during the test than I had anticipated (from my doctor's reassurances). I felt a great deal of cramp-like pain during the procedure, in spite of the sedative. I understand from others that the choice of doctor can
make the difference in the comfort of the patient. Can you guess why one doctor would make the test less objectionable than another? I am not interested in condemning anyone, just curious. Thank you. Cathy
Dear Cathy,
Congratulations on having a normal colonoscopy. I assume from your letter that this was your first colonoscopy. The cramp-like pain associated with colonoscopy can be the result of distention of the bowel with air (necessary for adequate visualization of the mucosa to exclude polyps) and/or stretching of the bowel as the scope moves toward the cecum. Patients with previous surgery, in particular a hysterectomy, often have discomfort during the colonoscopy.
You are correct that physician technique (including the quantity and type of sedation used during the test) can affect the amount of pain that the patient experiences. However, a patient having several colonoscopies by the same physician may notice that some of the tests are more uncomfortable than
others.
What are the early symptoms of colon cancer? Are there other conditions that cause similar symptoms? Does a lump in the rectum always indicate colon cancer. What recommendations can you offer me regarding these particular symptoms?
Thank you in advance for your help and response. It is
appreciated. Stefanos
Dear Mr.Stefanos:
The risk of developing colorectal cancer depends on a number of factors. The most important ones are:
Age.
Personal history of and previous
colon cancer.
Family history of colonic polyps or colon cancer.
Ulcerative colitis also increases the risk f developing colorectal cancer.
The risk rises after age 40 with almost all
cancers occurring in persons aged 50 years and older. The majority of colorectal
cancers arise from a benign mushroom like growth on the lining of the large
bowel called "polyp" but not all polyps will become cancerous. Any
individual older that 50 years old with no other risk factors except for his or
her age ("average risk" for colon cancer) should have regular
screening for colorectal cancer.
The most accepted approach is:
Testing a sample of stool for small amount of blood
that is not visible ("occult blood in stool") every year.
Sigmoidoscopy every 3 to 5 years. A sigmoidoscopy is a test that uses a flexible thin tube, with a light and a video camera on the tip. This tube is introduced through the rectum to visualize the lower part of the colon.
With these test we can also take samples of any abnormal area and remove polyps if present.
Colon cancer is usually a "silent" (without any symptoms) condition. That is why screening tests are recommended. There are multiple causes for rectal bleeding, like hemorrhoids, anal fissure (like a tear in the lining of the anus), abnormal blood vessels, diverticulosis (weak air
pockets areas of the colonic wall), tumors, etc. There are also many different causes for a lump in the anal area.
Regardless of your age, you should be seen by a physician in view of your rectal bleeding and anal lump. Based on your age and other risk factors as well as on your physical findings, your doctor will decide what kind of test you should have.
What are the most current treatments for colon cancer (early stage in a young female)? Is 5FU the best treatment? Susan
Dear Susan:
Appropriate treatment for colon cancer depends on the tumor stage at diagnosis. Tumor stage is determined by:
The depth of invasion of the bowel wall.
The presence or absence of local (lymph node)
involvement.
Distant metastases (e.g. to the liver).
Early stage tumors which are not associated with spread to lymph nodes or distant sites can be treated with surgery alone. If lymph nodes are involved,adjuvant therapy is recommended. The most common adjuvant therapy includes the drugs 5-fluorouracil (5FU) and levanisole. If the tumor has spread
to distant sites, such as the liver, therapy should be individualized but most treatments include 5FU and leucovorin.
