Digestive, Stomach and Bowel Problems (including haemorrhoids but not cancer)

Archive Page
This is archive material from the MHF's malehealth.co.uk website which is now part of this site in the section Male Health. This page remains on the site as site traffic suggests visitors find this page useful but it may not be up to date. It was last updated in 2003 and so does not conform to the NHS England Information Standard of which the MHF is a member. Up-to-date information on this topic can be found here: Stomach FAQs.

 

Cramps and itchiness

Q. Two to three times a month I have a cramp type pain in my back passage, that lasts 10-15 mins. I have to get on my hands and knees to get rid of the pain. I also get itchy anus through the night.

A. I'm afraid I would need more information not least your age and any other change in bowel habit. Is this occurring at any particular time or after certain food? Are you passing any very dark motions or blood? Are you routinely constipated?

I would suggest some common sense things like increasing the amount of fibre in your diet which will give bulk to the stool. Is the itchiness there only when you have the pain or all the time? Fungal infections and thread worm tend to cause nocturnal itch at the anus. Check with a mirror for reddening of the anal ring or in the stool for fine white thread worms. Your pharmacist and GP can help. I suggest you see your GP anyway to clear this up.

Bowel problem

Q. I have had piles for a number of years now which go through phases of painfulness. I haven't had any formal treatment but occasionally use a specialist cream to treat them.

However, I have recently experienced a problem towards the end of the passing of a motion - I still feel like I need to go but nothing comes out. This isn't painful but I am starting to become worried that this could be something more sinister. Do I have need for concern? I am 35 years old.

A. Such a useful question for all the guys out there wondering if they are dying from some cancer. Piles do tend to make you feel as though you haven't quite finished passing motions. This is also true of eating very spicy foods or too much booze on a regular basis. It can be a sign of bowel cancer but thankfully rare at your age. Even so I would get this checked out by your GP.

Problems with flatulence

Q. For a couple of years I have now suffered from severe flatulence, especially immediately after eating. The only thing that seems to relieve the symptoms is passing a stool, but this is only for a couple of hours at the most. I have tried most over the counter remedies, eg gaviscon and would welocome some suggestions.

A. Obviously it is impossible to give you a definitive diagnosis without examination and more information but what you describe is very common. There is only a number of ways that gas can build up in the bowel and most of these are due to the breakdown of food. It sounds as though you are suffering from an irritable bowel and you may find relief by closely watching for those foods, such as coffee, that cause the discomfort in the first place. Age is a big factor as is any previous medical or family history so you should see your GP.

Anal rash

Q. I have some haemmorroids, however I have recently acquired a rash in my anal area which is persistent and itchy. The skin is somewhat inflamed and there is a white powderish residue present. Is this a heat rash or a fungi? Note: I have been bathing at local pool--does this have any significance. My partner is also suffering from this affliction.

A. Itchy bums are very common and unfortunately often not helped by some of the treatments we try. Steroid creams, often used for piles can be a big culprit when used for too long. This can cause skin shining and fungal infection. Try wearing cotton boxers and stop any steroid creams. If it is fungal you can try something like Canesten from your pharmacist. The fact that your partner also suffers from this does tend to imply that it is fungal in nature.

Sudden severe pain linked with constipation?

Q. Yesterday, while I was walking to work I felt this severe pain - almost like I had just been kicked between the legs. The pain was there until I was able to sit down at work when it slowly disappeared.

The pain didn't reappear that morning when I had a few short walks around the office, but at lunchtime I went for a longer walk, after about 10 minutes the pain returned - it got really bad. I almost had to sit down and it slowly disappeared once I got back to work and was sitting down. I haven't felt it since, but I haven't been doing any walking or much standing up and I was a bit concerned about what it was.

I am 22, underweight and I don't do any strenuous exercise. I have been having quite bad constipation for the past few months though.

A. These kind of problems are the ones where it would be nice to have a much faster return on the answer. Unfortunately this site is so popular we can hardly cope with the number of questions pouring in but I do apologise.

There are two things which come to mind but which require more information, tests and examination to be sure. Kidney stones moving down the ureter (the pipe from kidney to bladder) are notorious for causing severe back to groin pain. It only happens as the stone is moving so it should eventually get out on its own and you may even pass some gravel.

You should see your GP who will arrange for a special type of X ray. It less likely to be a case of intermittent torsion of the testicle where the testicle rotates on its own blood supply causing terrible pain and tenderness at the testicle. Again you should see your GP. I suspect you know what it is by now so perhaps you might like to write in again.

Anal bleeding and stomach pains

Q. Occasionally, I suffer from anal bleeding from bowel movements. There is enough blood that the water turns almost completely red. Sometimes, when this happens it hurts and the faeces is hard. And I get sharp pains in my stomach at random times. Could you please tell me what this could be? Thank you.

A. It would be useful to know your age and any previous history but basically I think I can tell you to relax, particularly when you are on the loo. Blood which is coming from higher up the bowel will appear as a dark brown/black tar-like substance which sticks to the loo pan and is hard to flush. This can be a sign of cancer or ulceration of the bowel. Blood which sits on the outside of the stool and is bright red is more likely to come from piles or an anal tear. Hard stools are a good cause. Even so, any bleeding from the anus needs the attention of your doctor.

Anal itching but not haemorrhoids

Q. I have been using haemorrhoid ointment almost continuously (at least 90 days out of every 100) for the last 10 years. I don't seem to have any lumps and the ointment generally cures the extreme itchiness I am suffering from. I was examined for haemorrhoids 10 years ago and told I didn't have them which is great, but 10 years on I am still suffering from an extremely embarassing and quite often extremely painful complaint due to excessive scratching.

Any solutions??

A. If you don't have piles, and it is a fairly simple check to confirm this, it is pointless to use creams for their treatment. As these often contain steroids it will make the skin thin over such a long period of time. Itchy bums are as common as, erm, itchy bums and very often there is no obvious cause. Try all the obvious things first like stopping using the creams, wearing cotton underwear, loose trousers, use an antifungal cream for a week, but most of all ask your GP for advice. Proctitis is common but it very rarely means there is something terrible happening.

Problem with eating

Q. I have had a problem digesting my food for nearly 2 months. I always feel as if I have overeaten regardless of how little I have eaten and have a strange sensation in my throat. I work out regurlarly and have no problem with emptying my bowels. Due to this I have decided to reduce my meals to once a day.

A. I would really need more information and your age. It sounds as though you may have a problem with your oesophagus (gullet) or stomach. If you are losing weight for no good reason, vomiting dark brown stuff or passing black stools you must see your GP.

What else can I try for IBS?

Q. I was diagnosed with IBS 4 years ago and had all the usual tests to eliminate other causes. Endescopy, colonoscpopy, barium enema C/T scan of abdomen, ultrasound test on three diffeent occassions, spinal x-ray.

I have been on a high fibre diet for the best part of these last four years but without relief. In addition to conventional medicine have tried a chinese doctor, homeopathy, osteopathy and chiropractisioner. I am trying acupunture at the moment coupled to a high fibre diet and after reading the latest from the US I am about to try psychotherapy.

I feel I am going round in circles.

Have you any suggestions to make because the position is now getting desperate after four years without pain in my left abdomen, no diarrhoea or constipation but just going on and on without relief. It has persisted for so long without relief I am seriousy considering having the bowel removed and replaced with a bag. Desperation indeed.

Any assistance would be greatly appreciated.

A. You really sound as though you are at the end of your tether but on the plus side because this has been going on for so long the nasties like cancer are very unlikely.

Crohn's disease often presents this way. It is an inflammatory bowel disorder but you usually also have absorption problems as well. After all the tests you describe it is most unlikely to be diverticulitis and serious inflammatory disorders of the large bowel are ruled out. I'm afraid I am at a loss to give you any definitive advice other than not to pursue a colostomy without eliminating all other routes first. It is a lot easier to perform than to reverse.

Blood in stools and other concerns

Q. I have contacted you before and received a reply (28/3) about pain in the right hand side of the groin after ejaculation. But I would like some further advice.

I have just been discharged by the General Surgery Doctor who was seeing me because they could not find any physical problem with me. I have had X-rays on my back and side (nothing found), urine tests which found no re-infection (would a general urine test pick up prostate infection?) and blood tests. All have found me to be in good health. He suggested that since the pain felt like a nerve problem that maybe the cause was due to the fact I am a natural worrier (grey hairs at 22!) and tend to tense up quite a bit. He suggested that I make an appointment with my GP and discuss possible counselling.

However, since being discharged I'm still getting pain and even large amount of blood in my stools when I get the groin pain. Would a general nervous disposition cause such problems (coupled with my history of prostate infection)? As you can imagine my worrying about the pain and the effect of my worrying is causing me to get a vicious circle.

To ease my mind a little could this problem be related to stress and tension or could there be an actual injury which is actually aggravating my nerves? I know you're not in the best position to provide a diagnosis but any advice would be gratefully received.

Frequent bowel habit

Q. I have to go to the toilet, for a number two, frequently. Sometimes I daren't go far from my house in case the compulsion comes on. When I go to the gym, on the jogging machine, I usually get the unstoppable urge after about half a mile...go to the loo...back on the machine and, often have to go again!!! I do suffer from piles..get bright red blood at times from my back passage..sometimes the stool are long and thin (thumb thickness at least..not as thin as a pencil), sometimes numerous and small, sometimes like smaller versions of a normal 'turd', sometimes like an explosion of curry sauce! I haven't lost weight, but do feel tired a lot.

I did suffer a 'nervous breakdown', am still on Prozac and was forced to take ill health retirement as a teacher. Though my bowel problems have been with me prior to my breakdown. Have been investigated by the doctor's finger...arse ring a bit inflammed, but nothing up there...do get a fluid/mucous discharge...possibility of diverticulitis? Is irritable bowel syndrome the most likely problem?

A. This is the kind of question which many men want to hear. There can be many reasons for why you are suffering from this problem and most of them are simple. I am loathe, however, to put things down to 'obsession' or being all in the mind until the other causes have been eliminated. I strongly advise you to ask your GP for a specialist opinion and if he or she will not do so, either go privately for an opinion or change GP. As an old lefty you will realise how difficult it is for me to give this kind of advice but this does need to be sorted out, and soon, if only to give you peace of mind.

Distended stomach

Q. I'm 28, I eat healthy and am a vegetarian. I don't drink and don't smoke. I go to the gym, play sports and so on fairly regularly. My fitness level is fairly good. My body level fat does not seem to be a high and even the fat in my stomach is not that high. However my stomach is still fairly large. I often feel very bloated and feel that my stomach is inflated rather than fat. My girlfriend mentioned that it could be due to water retention. I am not sure that men suffer from it. If so, what can I do about it? I heard about herbal medicines that you can take. There is something also about a stomach water retention wrap? Is there any exercises I can do? I am getting quite demoralised with people making fun of my stomach when in general I am usually in a better fitness condition than they are. So any help would be much appreciated. Thankyou

A. Relax. There is more rubbish going around about this 'water retention'. Your body retains the amount of water it needs in your blood and it only seeps out into your tissues when your heart is not working properly or you have a serious liver/blood condition. You do not 'retain water' in your stomach. It has acid in there but any distension is usually due either to food or gas. If you are slim it will show particularly after having a meal or drinking a large amount of fluids. Some herbal 'water tablets' are extremely dangerous and you should not consider taking diuretics without the advice of your doctor.

Rectal bleeding and pains

Q. This question is for my concern for my husband. He has rectal bleeding off and on now for at least 2 years with out having it checked out. He has a very horrible pain in his lower buttock on one side and hip area for 3 months now and refuses to have it checked out. My question is what can this be? Should I be worried? He is 41 years old and is a drinker and smoker. He said that the pain is just probably a pulled musle. If this was the case shouldn't it have been gone by now?

Concerned

A. Thank goodness women are checking this site out as well as men. There is hope for the male population yet. The good news is that it is unlikely to be something dreadful because he would be dead by now. It sounds as though he may have an anal tear which can become infected and inflamed causing pain, especially during the passing of stool. He may be trying local anaesthetic gels which work for a short time but eventually make the whole thing worse. One way to tell is to look at the stool. If the blood streaks the outside only of the stool, it is coming from very low down in the bowel, probably right at the anal ring itself. If the blood is dark brown/black like tar it is coming from higher up in the bowel.

Either way he needs to be checked out. One way is to talk to his GP about your fears. They will work out a way of seeing him. Alternatively, arrange a meeting with your GP for you with him there and mention his problem at the same time. Finally you can just confront him with your fear and ask him to see his doctor because you are so scared. Yes, it's called blackmail but it works. Let me know how you get on.

Abdominal pain

Q. For the last six months I have experienced constant abdominal pain. Although several investigations including gastroscopy, ultrasound and CT scan have already been undertaken nothing has been found to be the cause. I was previously admitted to hospital with a blockage of air in the large bowel which was treated. After discharge the pain returned and has remained since. Any ideas?

A. I'm afraid it is impossible to give you a definitive answer without more information, not least your diet, age, previous medical history, occupation and family medical history. I would really like to know what the 'large blockage of air' was. The bowel should not normally be distended by air which is blocked. You may have an irritable bowel and should try to remove some of the dietary factors which are known to cause the irritation. There is more information on this site about the subject.

Mother worried about son's bowel problem

Q. My son went into hospital with abdominal pain on his left side. They took an x-ray and said that he was impacted with stool. So assumed that the pain was caused by this. They diagnosed constipation. I did not agree with this because my son has always been to the toilet and has never withheld his stools. He has never had difficulty in passing his stools, they are not hard to pass either. He has a very good diet, enjoys school and leads a very active life and only complains if he has a problem. He was first given and enema, which he passed a large normal stool. They then gave him the picolax, nothing happened. They gave him another emema, very loose stools. They then gave him the Picolax, Lactulose and Senna. He had all this medicine for 7 days and no more result. They said he was fine and discharged him.

His tummy became distended, I took him back to another hospital. He had 10 enemas in that week including all the previous medicines and nothing happened. They gave him a manual evacuation and nothing came out. He was discharged without passing any bowel.

He got worse and had to be admitted to hospital again. They gave him another enema with all the other medicines, he passed a small stool. Over couple of days they did blood tests, a biopsy and they all came back negative. They decided to give him Kleen Prep for five days. The first day he passed large mushy stool. The next four days nothing. They decided that he was making it up, told him to stay of dairy products for two weeks and referred him to a psychologist.

My son is only 13 and in the space of eight weeks he has not been able to go to the toilet without the aid of an enema or some really strong medicine. He has still got a lot of tender pain when touched on the left side. But I feel because the Doctors cannot find out what the problem is, it boils down to something pyschological. I've tried to tell them that his colon could have been slow before but now with all these laxatives it has completely given up, but they say that is not the problem. They believe he is holding it in. I don't know if the abdominal pain has anything to do with his bowels, but if it is the medicines they are giving him are not working. He was going to the toilet fine before he went in the hospital and as soon as the gave him the enema he doesn't go at all now.

What am I to do — my son needs all the help I can give because no-one else is.

A very frustrated and disheartened mother

A. As a father of four my heart goes out to you. As a doctor I share the frustration of being part of a service which cannot always give an answer which is acceptable and - unfortunately - always correct. Obviously it is impossible for me to make any kind of definitive comment without seeing his notes and talking to his doctors as well. Even so, it is deplorable that a young man has suffered these most unpleasant procedures.

It is possible that he is holding it in but I notice that he is not passing very much despite the large amounts of laxatives. Obviously there cannot be any impaction if there is no stool present. He cannot therefore be deliberately holding anything in. I would suggest you ask for a referral (not as an emergency) to a gastroenterologist while acquiescing to the visit to the psychiatrist. Sorry I cannot be of any more help. Please let me know how you get on.

Stomach problems

Q. I am 19 years of age and a month ago I developed this problem whereby I found myself constantly burping. With this I have been getting severe stomach upsets which I have suffered from throughout my life but since the burping it has become much more regular i.e 1 or 2 times a week. With the stomach upsets I experience stomach cramps and diahrroea. I would appreciate it if you could give me some advice as to what it could be as it is now becoming quite worrying for me.

A. One of the big problems over discussing the 'stomach' is the different ways it is used to describe a problem. Some people will talk about their 'stomach' meaning their abdomen. Other refer to the stomach to describe a bowel problem. I think it would be wise if I stuck to the burping part of your question as it can only be related to the real stomach.

There are only two ways burps can occur. Gas can be produced in the stomach itself generally through medicines containing calcium carbonate - the antacids are a good example. These react with the hydrochloric acid of the stomach to produce carbon dioxide which can only escape through burping. Some food will do the same thing only not generally so dramatic. The other way is by swallowing air while eating. Air is not absorbed in the gut and can only escape through belching. Most of us will swallow air during a meal, especially while drinking and talking at the same time.

If you have any irritation of the stomach, belching can either make it worse, or for some people, make it feel much better probably through releasing the distension. If you are taking antacids regularly for a stomach complaint it will increase belching but may also, depending on the preparation, increase loose stools. Milk of Magnesia is a good example. I recommend you start from scratch, see your GP and then work out the best way of dealing with it rather than hoping it will sort itself out.

Concern about large stomach

Q. I have a stomach which looks like i am 9 months pregnant! It sticks out a lot, especially after eating but I am not overweight. There is no fat around it, but bloated. I once remember hearing the term "low stomach". Is this a real medical problem and what can I do to reduce the size of it?

A. I've heard of a low slung bum but not the stomach variety. I would need to know your age and weight but I suspect you are young and thin. Young men eat and drink with a hippopotamus as their role model. Calories are burned off in the lifestyle which would give a hippo indigestion.

Your stomach can hold a gallon or so of food and fluids and it won't let go of it until the rest of your digestive tract is ready to digest it all. Fatty food is the most difficult to break down so it is held the longest. Huge amounts of beer slows down the digestive process so it tends to stay in the stomach for even longer. Carrots are generally thrown in for free.

If you are thin the stomach distension is clearly visible but it tends to force the loose gut out against the abdominal wall. This is why it appears lower down. It is not a medical problem but it can be a big put off for the missionary position. Not for you as much as the missionary. Reducing this problem is simple, stop going out with missionaries!

Sharp pains in rectum

Q. I have been experiencing some very severe sharp pains in my rectum. My lower stomach also hurts only sometimes right after I feel the sharp pains in my rectum. I have not seen any blood after bowel movements, but it does feel as though a ball or something is trying to come out. Could this be hemmroids or could it be signs of something else?

Thank you

A. You are right to be cautious. It is obviously impossible to give you a definitive diagnosis without an examination and tests and I would really need to know your age and previous medical history. Rectal cancer is rare in men under 40 years but any changes in bowel habit or internal feeling should be check by your doctor. The good news is that it is very treatable when caught early. More good news is that piles and fissures in the anus are far more common and are not life threatening. I strongly advise that you put your mind at rest by seeing your GP.

Recurrent anal itching

Q. For the past 13 years I have been dealing with severe annal itching. One doctor diagnosed it as a yeast infection gave me a cream, but it keeps reccurring. I've also been tested for hemorrhoids - but the ones I sometimes get are minor and are caused no doubt by the constant scratching to alleviate the itch. What should I do? Is there such a thing as a male yeast infection? What is causing this?

A. Yes, a yeast infection like Candida (thrush) will cause itchiness at the little star fish and yes, so will piles but then so will threadworms. These intimate friendly little chapettes like to lay their eggs around the anal ring at night. No, don't ask me how they know when the lights go out, but they do. You scratch the area, suck your thumb and presto, the whole thing starts again. Better still if you handle food for someone else they will share the relationship. A single dose of medicine prescribed by your GP will get rid of them but they can come back.

An anal fissure -a tear in the anal ring - can be intensely itchy and sore. Creams with small amounts of steroid can help the itchiness but it is far better to solve the problem for good by getting your GP to take a good look at the offending ring and refer you or prescribe the right medicine. Most of us put the GP off, especially if it is a woman, from a good examination so they tend to use the Braille method. If it is a recurrent thrush infection and especially if it is also infecting your mouth as well, you should ask your GP for all the tests of reduced immunity.

Cyst

Q. I am a normally healthy and active 36 year old male. I have recently developed what I think is a cyst at the outer part of my back passage. It is not so much sore as uncomfortable and I am concerned that it may get larger. Would this need to be looked at or can I get over the counter drugs or treatment?

A. Anything, and I mean anything, which makes riding a bike, sitting on a hard bench or makes a mess of your undies needs to be checked by someone who knows about these things, other than yourself. The simple reason is that unless you have a very long neck or an understanding partner, checking out your backside is very difficult.

Worse still us men tend to put off seeing our doctors about anything below the belt at the best of times.

You may well have either an anal fissure - a crack in the anal ring - or piles. Neither will kill you but they can both be treated by your GP to reduce your misery. A prolapsed rectum can also happen where part of the internal lining of the anus sits outside of the body. It looks very red and can be uncomfortable. It often returns to its right place after passing a motion. Straining doesn't help so watching your diet can do the trick. More rarely, cancer can set up home and the good news is that with early diagnosis it is almost always totally treatable.

Personally, I would want someone to see what is going on down there before I sat back, painfully, and relaxed. See your GP, you don't have to sit in the waiting room.

Stomach tenderness

Q. I have a tender, and when pressed, very tender spot at the bottom left hand of my stomach. There is a slight change in my toilet habit (both duties) although I have experienced this before without any sign of tenderness. This has lasted about three days now.

A. Harold Wilson once said that a week was a long time in politics. Three days in the course of any condition which is unlikely to cancel your subscription to Readers Digest is on the short side. Even so I take any observation by a patient of tenderness in one place in the abdomen very seriously.

The good news is that changes in toilet habit are usually quite separate. People describe their body differently - the 'stomach' can mean all the abdomen while 'belly' can mean the lower bit which sticks out in people like me. If you have tenderness in the left side of the lower part of your abdomen, just above your pelvis it is more likely to be a problem with the large bowel rather than the stomach which sits high in the abdomen, just under the rib cage. Irritable bowel syndrome will cause changes in bowel habit and can be provoked by foods like coffee and alcohol.

I would really need more details not least your age and previous medical history so I suggest you see your own GP.

Loose stools and lethargy at 81

Q. I have loose stools and sore anus. I also have attacks of lethargy. I am 81 and have a pacemaker fitted. I have had a triple by-pass (1988) gallbladder removed together with massive stone (1998) I take wafarin, Lozec, frusemide, zestril, and pravstatin. I also take 500 u Vit E and 200 Vit B.

A. My Dad is 81 this year so I will avoid saying that it is just your age for fear of him coming round and giving me a clout around the ear. Age is the great excuse for most things that go wrong with people. A bit of digging often finds that there is a very good reason other than too many birthdays. You are taking Vit E which is an antioxidant with possible anti cancer and anti coagulant properties. It also, unfortunately can cause loose stools along with easy bleeding from the bowel. If you combine this with Warfarin, aspirin, grapefruit juice and any blood thinners it can make the whole thing worse.

You should talk to your GP who may be unaware that you are taking Vit E along with your Warfarin. Your lethargy may be from chronic blood loss and being anaemic. Again a blood test will establish this with simple remedy. My Dad always said you can take a horse to water but a pencil must be lead. Sometimes you need to show your GP the trough.

Stomach problems

Q. I have a lot of stomach pain, burning, bloating with a lot of nausea, I have a history of taking six goodies powders a day because of headaches daily mostly sinus. I can't eat anything fried without suffering. I have been treated for acid reflux but now I'm having this promblem. What could it be? thank you.

A. I'm not sure what a 'goodies powder' is but I suspect it may contain aspirin. If so it will cause gastric erosion or an ulcer on a major scale if taken so regularly. Fried food will make this worse as will alcohol. You may well have either a peptic ulcer or a problem with your gall bladder. Stop taking the powders - constant use only makes the headache worse anyway - and see your GP if this has no effect. If your motions (stools, shit, poo) are black like tar see your GP right away as you may be bleeding from the erosion or ulcer. Rare now, but still possible, is cancer of the stomach which makes your visit to the GP even more important.

Bleeding from colon

Q. I have been having a problem that when I go to the bathroom I have been bleeding from my colon. I went to the doctor and he told me it was internal haemorrhage. What do you think I should do to cure it because the cream he prescribed is not having any effect?

A. I think you may have a breakdown in communication over this problem. The GP may have been talking about an internal pile. Piles will cause bleeding and creams will not always solve the problem. Surgery is often the best solution so you would need to be seen by a specialist. Anal fissures, at the anal ring will also cause bleeding. More seriously, rectal cancer can cause bleeding although it is uncommon in men under 35. Basically you need to be seen by a specialist if it is not getting any better.

What is acid reflux?

Q. What is acid reflux and what causes it? What is the prognosis?

A. Acid reflux refers to reflux (coming up) of contents of the stomach, usually very acidic, into the oesophagus or gullet. This is common (up to 10-15% of the population have experienced the symptom of heartburn) and can be very uncomfortable. Symptoms can be worse after meals, acidic or spicy foods, aggravated by bending over or lying flat.

The cause is thought to be relaxation of the lower oesophageal sphincter - that is the muscle between the oesopahagus and the stomach. Prognosis is usually very good but depends on the presence or absence of complications such as narrowing of the gullet (called a stricture) or change in the lining of the gullet to resemble that of the stomach (referred to as "Barretts oesophagus" after the physician who first described it).

Difficulty in swallowing and pre-cancerous cells

Q. I have had an Hiatus Hernia for years and in recent years suffered badly from reflux action which has damaged the lining of my throat.

My specialist has twice examined me by way of endoscopy and told me that my throat shows signs of pre-cancerous cells. Does this lead to cancer and should I have difficulty in swallowing which I suffer?

A. By definition, if your specialist has said there are precancerous cells, this suggests a risk of progression. However there are different sorts of precancerous cells and cancerous cells and this may be treatable. Difficulty swallowing can be a complication of scarring or narrowing of the gullet and should always be taken seriously. It sounds as though you have had the right investigations done. You sould go back and discuss this in more detail with your specialist.

Is cancer hereditary?

Q. My mother died in 1988 with a cancer on her brain after having bowel cancer 2 years earlier.

My younger brother (he's 45, I'm 47) has just been informed he has an inoperable cancerous tumour in his gut. He has been told by his consultant that he is not optimistic re the future and to get his affairs in order. He will see another consultant next Monday who specialises in cancer to hopefully let him know exactly where in the gut it is. From the CAT scans and operation he had last Thursday (one week ago) they were unable to determine exactly what the tumour is attached to. They say it is a good possibility that it is attached to the panceas.

Any advice/help would be greatly appreciated.

A. It sounds as though some of my colleagues need a course on empathic communication. You and your family have gone through and still are experiencing some terrible times. There is nothing I can say or do to make things better for your brother but at least remember this, I have seen many, many people go through what we all must do. The great difference is the amount of love and support from friends and relatives. For some people there is nothing except the hospital and the professional staff who at best can only give what they can in these hard driven times. Your brother is fortunate in having someone who cares and believe me this really does make all the difference.

It is frankly impossible for me to comment on your brother's medical state without all the medical records to hand. You do ask if cancer is inherited and my sad answer is that part of it is. Even so, knowing that there is an increased risk can often save a person simply from the knowledge. If bowel cancer runs in the family it is sensible to have regular checks because an early diagnosis can almost guarantee survival. If you are aware that driving can be hazardous you wear a seat belt. This does not make driving any the less enjoyable. Similarly with life. Knowing your risks and taking the right precautions should not make life miserable.

It may be useful to eat a high fibre diet with plenty of fruit. Antioxidant vitamin supplements just might afford protection as well, but most important you should discuss with your doctor a regular check up. I am sorry I cannot be of more help. As someone who has survived bowel cancer I can tell you that your brother's experience should not be in vain.

OTC product for piles?

Q. I am suffering from anal soreness, itching and burning. I have suffered with piles before and realise this is probably a recurrence. What I want to know can you recommend a reliable over-the-counter treatment to ease the pain?

A. Don't jump to the conclusion that you have piles. The symptoms you describe can be caused by other things. requent passing of motions, especially after too much alcohol, is a common reason. Thrush infection if you are diabetic, on steroids or taking long courses of antibiotics will also cause these symptoms. Anal fissures (tears) are also common and cause an intense pain on passing motions and, yes, piles will also mimic all of these things. It is rarely a sign of anything serious but if you are passing blood, losing weight or have constant diarrhoea it needs checked out by your doctor.

Avoid overuse of local anaesthetic or steroid creams as they only help in the short term. Using a soft toilet paper or washing instead after passing motions can help enormously. If you do have piles and they are protruding, gently return them to their proper place while in a warm bath. Surgery may be an option if they become thrombosed.

Over-the-counter treatments should only be used for a short time and include the likes of mild steroid creams. If the problem persists you need to see your GP in the bend over position much favoured by Yes Minister officials.

Bleeding from anus when run down

Q. When I am feeling run down I suffer bleeding from the anus. The blood is bright red and not in the stools. In fact it sometimes spurts straight into the bowl. It sounds like an anal fissure, except there is no pain. Should I be worried?

A. It is difficult to relate the loss of bright red blood with your feeling of being run down and which comes first. For blood to be bright red it must be very close to the anus otherwise it changes colour very rapidly to a black tar-like substance. Piles will cause this kind of blood loss and it is not always painful. You may be able to feel them if they protrude out of the anus itself. Yes, anal fissures will also cause this type of bleeding but the anus is usually sore and itchy particularly while passing a motion.

A more rare cause is a rectal polyp. These are small growths from the wall of the bowel which can be quite elongated. They sometimes protrude out of the anus and are very friable so tend to bleed easily. Although they are a tumour they are not serious if caught early. Ignoring them is not a good idea as they can grow into the bowel wall and spread. This type of tumour can run in families so check if any of your close relatives ever had similar problems.

At the very least you should see your own doctor. All of these things can be treated very well, even a tumour you might be surprised to know.

Loose stools

Q. I always have a very loose liquid stool in the morning & when I have the first sip of my milk or juice I need to go to the lavatory again, but then it's normal for the rest of the day. Why is this??

A. Bowel irritation is the commonest cause of loose stool and this can range from one episode through to full blown diarrhoea. Unfortunately the list of causes for irritation is long and I would need more information about your diet, lifestyle, medical history and medications you are taking at present.

A commonly overlooked cause is medication for some other problem (long term antibiotics are a classic cause). Some vitamin or herbal supplements can also cause a loose stool. Vitamins E & C in large doses are typical causes. Ask your pharmacist to check for you. Irritable bowel syndrome (IBS) will also cause loose stools but there is usually a painful cramp associated with it. Some inflammatory disorders such as Crohn's or pancreatic disorders will also have the same effect. Alcohol abuse is a very common cause and is easy to both diagnose and treat by yourself.

You should discuss this with your doctor particularly if there is any blood in the stool, you are losing weight for no apparent reason or there is any family history of bowel disorders.

Tape worm?

Q. I am 23 years old, and I have noticed something moving in my stomach,(above navel and below chestbone). I have not felt very hungry for the past three days, only eating the occasional sausage sandwich, but this morning I had 7 slices of toast and marmite for breakfast. I am worried that I might have a tape worm. On the previous Sunday, I was out drinking from 2pm till 11pm. My mum thinks that might be something to do with it. What is wrong?

A. Although this sounds horribly like a re-run of 'Alien', I can reassure you that not only is nothing going to burst out of your abdomen and destroy the whole family, but you are most unlikely to have tapeworms either as they are now rare. The pork tapeworm is virtually extinct in Europe and the beef tapeworm lingers on in those countries which favour eating rare beef. Most people are totally unaware of tapeworms and they are only of any significant medical risk in debilitated people. You can have your stool checked for eggs but you are much more likely to have worms (thread worms, round worms) than a tape worm.

What you describe is often seen in thin people as the gut moving under the muscle can sometimes be seen. This movement is caused by peristalsis, a rhythmic squeezing which forces the food down the digestive tract. Paradoxically you can often see it better when you are really hungry and have not eaten for a while. Alternatively it is the contraction muscles which lie over the abdomen. They often contract on their own without you thinking about it. This maintains their tone and prevents a hernia.

Baby with inguinal hernia

Q. My baby was born in September and ever since has a swelling which comes and goes in his right groin. What is this?

A. This is likely to be an inguinal hernia and is often present on crying. The hernia usually comes and goes and may not be present all the time. However, there is a small risk of the hernia staying down and becoming stuck. This may be very painful and he will be distressed and cry a great deal or possibly vomit.

If you suspect an inguinal hernia is present you should see your GP and it is likely that the GP will refer baby to a surgeon who deals with children. As there is a small risk of the bowel coming down and being stuck in the hernia, an operation should be undertaken semi-urgently (hopefully within two or three months).

Beer and cider make me sick

Q. I had a operation a few years ago, for a strangulated hernia. Before I had the OP, I could drink a beer, nearly any kind of beer, but since I had the OP, I can only drink cider, as the beer makes me sick, and as lately the cider is also making me feel sick. I do not drink often - maybe 2/3 times a week - and even then it would only be a few pints. My stomach always feels bloated. Can you explain this to me, as I think it to be very strange,and I am starting to worry a lot about it.

A. Firstly relax. From what you describe I don't feel there is anything dreadful going on. Hernias in men are predominately of the inguinal variety. A loop of bowel protrudes through the muscle wall at the weakest link just above the groin-thigh interface. If this loop is strangulated by the surrounding muscle it can be very serious, especially if you are older. Otherwise a hernia repair sorts things out virtually back to normal.

There is no connection with the stomach and it should not cause any change in bowel behaviour. Even so, simply cutting into the muscles and handling the bowel can cause some adhesions - fibrous bands - which stick to the bowel and make it less mobile. This is much more likely if the gut strangulated. Depending on the condition of the strangulated loop of bowel, how long it was without blood and any leakage from it, a small part of the bowel may have needed to be removed. This increases the risk from adhesions.

Most of the gut moves freely inside the abdomen. It has to allow proper digestion. If this is disturbed by adhesions you may find that this affects your tolerance of certain foods and possibly beer. On the other hand, it is usually solid food and, in particular, hard to digest food which causes the most problem and beer can hardly be described in this way although some brews may qualify. I cannot give you a definitive answer without more information and a physical examination. You should discuss this with your GP.

Gastric problem

Q. I have had a bad gastric problem (flatulence, bloating, belching) for the past 6 years. Eventually quacktors in London determined that I have some problem with oesophageal reflux causing scarring necessitating some sort of operation. BUT, they consistently seem to ignore the fact that on a regular basis my left heel gets sore and throbs, my left leg aches, my left testicle has a continual dull ache and occasionally sharp pains and that when this happens the bloating, flatulence, belching, farting and tiredness increases. Since I was issued with LOSEC a week ago, for the gastric problem, these symptoms have persisted and have now developed a dull ache across the base of my spine about level with the coccyx which makes it, sometimes, uncomfortable sitting down; and, standing up the left leg and heel throb. Background: In 1975 when visiting South Africa I got an infection - please don't ask me how or why - and my left testicle, within 4 days of arriving in Johannesburg, was twice the size and I could not walk on my left foot but on the balls of the foot.

Help!

A. You are an interesting and forthright man so I will be as equally open and honest. You present a complex mixture of symptoms which may or may not be connected. It is perectly possible to have more than one medical problem running side by side. On the other hand we are increasingly finding conections between apparently unrelated symptoms. The many manifestations of autoimmune diseases such as rheumatoid arthritis are a good example. You cite the infection picked up in SA as the start of your problems. You just might be correct. Reiter's syndrome is often linked with sexualy transmtted dieases. If the infection in your testicle came about in this way, it might just explain the baffling plethora of symptoms.

Concern about cancer

Q. I have recurring bouts of stomach problems ranging from painfull constipation and diarrhoea to bloating discomfort copious wind and stabbing pains. I do not however lose my appetite which I always read as the symptom indicating serious problems. I am more concerned lately as my father had surgery for oesophogeal cancer last year.

A. These sort of symptoms are very non-specific and can have a wide range of causes. Things to watch out for are unintentional loss of weight, vomiting, pain waking you up at night, or passage of any blood. Any of these should prompt a visit to your GP. The development of new digestive symptoms in someone over the age of 45 or with a posive family history will often lead to further investigation and perhaps referral to a specialist. The oesophagus or gullet takes food from the mouth to the stomach. Any problems in swallowing should prompt a visit to the GP.

Page created on May 13th, 2003

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