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TRUST YOUR GUT

Dr Pixie McKenna and Dr Sera Shoukru, private GP Partners at ‘Pixie and Sera’ based at The London Clinic, have over 30 years of combined experience.

In this feature, they stress the importance of not ignoring what could be going on with your stomach or bowel.

About Dr MCKenna

Dr McKenna specialises in all aspects of General Practice, lifestyle screening, sexual and reproductive health care and dermatology. 

Dr Pixie McKenna

Dr Pixie McKenna

About Dr Shoukru

Dr Shoukru specialises in all aspects of General Practice. She is a GP specialist in sexual and reproductive health care and complex contraceptive needs.

Dr Sera Shoukru

Dr Sera Shoukru

Gut gone on a go slow?

Constipation is a curse, making us feel heavy, bloated and uncomfortable. Causes can include illness, immobility, medications (codeine based pain killers, iron supplements and calcium) and dehydration. It may be part of irritable bowel syndrome or the by-product of a particular diet. 

Young man on sofa, clasping stomach

Fibre in the diet helps to form bulky stools, which are easier to pass. Remember the food we eat has to travel nine meters before it reaches the toilet bowl; so saying “Hi 5” to fibre makes sense if you want to speed things up. 

Laxatives work by softening the stool, bulking it up or stimulating the bowel to contract. They are no substitute for a healthy diet and should only ever be taken on medical advice. Prunes and figs are natural laxatives with the added benefit of counting as part of your five a day.

Being too embarrassed to pass a bowel motion in a public place can contribute to constipation, so answer the call to stool!  Exercising and good hydration will help keep your motions in check.

While constipation is common if the cause isn’t clear or the symptoms aren’t clearing, seek advice from your GP. Changes in bowel habits can be the first warning sign of colorectal cancer, although it could equally be something harmless.

Bowels behaving badly?

Bloating is an incredibly common symptom, which most of us experience at some point in time. Add in bouts of diarrhoea and/or constipation and crampy tummy pain and you have a very irritated gut, giving rise to what we call Irritable Bowel Syndrome (IBS). 

IBS is twice as likely to affect women, impacting one in five of us at some point in our lives. It normally starts in the 20s and 30s so a new diagnosis is unlikely and should raise questions in anyone over 40 years of age.

The symptoms tend to come and go and invariably you feel better after you have opened your bowels. The motions themselves can range from rabbit poo consistency to something similar to the contents of a baby’s nappy!

Flatulence can go hand in hand with these erratic motions but weight loss, blood and pain that keeps you awake at night are not features. Aim to eat regular meals and avoid processed foods, fizzy drinks, alcohol, and fatty or spicy food. A food diary helps to identify triggers.

Diagnosis is made based on your symptoms (there is no test) and while there is no cure, anti-spasmodic drugs (available through pharmacies) can be taken to help quell things. Doctors sometimes prescribe antidepressants to patients with IBS. They work on the nerves of the gut targeting its irritability. 

Dietitians are increasingly using a Low Fodmap Diet for IBS sufferers. Fodmaps are carbohydrates found in foods, which may not be digested or absorbed fully and as a result produce IBS type symptoms in sensitive individuals. Not all carbs are Fodmaps so a dietician’s advice is imperative.

Finally, as your gut is heavily innervated and IBS often kicks off in times of stress, acupuncture, hypnotherapy and cognitive behaviour may have benefits.

The bottom line is, we don’t really know why this IBS occurs. There is no diagnostic test and GPs tend to adopt a trial and error approach when it comes to treatment.

Blood in the toilet bowl?

Nothing scares a patient more than the sight of blood coming from the back passage. It may splat on the bowl, appear on the toilet paper or be mixed in with the motion. 

Haemorrhoids are a common cause. These are varicose veins of the tail end and 50% of us have them by the time we hit 50. Constipation, straining and old age can all be  triggers. Often the first notice you get that you have piles is when they produce blood. This is one time where self diagnosis is ill advised as your GP will need to take a look to confirm the its piles and start treatment in the form or a cream and/or a suppository. 

Other causes of blood from down below include any skin irritation that results in itching or scratching. Cracks in lining of the back passage may be at fault, opening up like a paper cut when you pass a motion. Inflammatory bowel disease and cancer can both cause bleeding so you can only be really be clear on the cause by having a check.

Chances of cancer?

Bowel cancer can be present for a long time before any symptoms appear so it makes sense to screen for it. If caught early you have a 90% chance of being alive in five years. Catch it late and this drops to almost 5%. 

The NHS screening programme in England and Wales invites everyone over the age of 60 to send a stool specimen in the post to check it for blood. Scotland offers this test at 50.

The test checks  for blood in the stool that is not visible to the naked eye, which may be the first sign that there is a growth in the gut. One in 50 people who take the test screen positive for blood and are referred on for a a colonoscopy.

Unfortunately many people are too embarrassed to take the postal test and so run the risk of literally dying of embarrassment. Symptoms of bowel cancer include change in bowel habit, weight loss, passage of blood, slime or mucous in the motions, stomach pain and fatigue.

While the internet is a wonderful resource in terms of self diagnosis there is no substitute for a face-to-face and hands-on consultation with a GP.

They are best placed to decipher your symptoms and refer you to see a specialist if they are concerned you have cancer.

Disclaimer

Any views expressed in this article are those of the featured consultant(s) and should not be considered to be the views or official policy of The London Clinic.

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