By Dr David Delvin

I want to tell you one simple fact - and it's a fact which could save your life.  It's this:

*** IN A PERSON AGED OVER 50, ANY UNEXPLAINED CHANGED IN BOWEL 'HABIT' SHOULD ALWAYS BE REPORTED TO THE DOCTOR.

Why?

Because - being quite blunt - bowel cancer is terribly common in this country.  The people who are most likely to get it are the over-50's.  And a frequently - encountered 'warning sign' of this disease is a sudden and unexplained CHANGE in your bowel habits.

In other words, if you suddenly become constipated - after years of normal bowel function - you should go to your GP for a check-up.

Similarly, if you develop persistent 'looseness' of the bowels, without any good reason, then again you need to ask your doc to check you over.

I have known people who've saved their lives by promptly reporting these symptoms.  But tragically, there are many folk who do NOT know that a mysterious  change in bowel habit can be serious.  So I have also seen patients who have neglected this symptom till it was too late.

Well, that's rather a gloomy warning to start with!  But I hope you'll file it away in your memory.  And if you're interested, there will be a little more about bowel cancer in the later part of this article.

However, what I want to do today is to give you a brief guide to everything you really need to know about your bowels, and to run through all the really common bowel disorders.  Let's' go!

But first, what ARE the bowels?  What does the word actually MEAN?

There's often a bit of misunderstanding about this.  People sometimes think that the word 'bowels' includes the waterworks, but that's not the case.

No: 'bowel' means that very very long piece of tubing that runs from your stomach to your bottom.  The words 'intestine' and 'gut' mean exactly the same thing.

The bowel is divided into:

*  THE SMALL BOWEL (small intestine)

*  THE LARGE BOWEL (large intestine)

In practice, when  people talk about 'bowel problems', they generally mean trouble arising in the LARGE bowel.  Now this is a tube, rather like a wide hosepipe - and it's about five feet long.

If you imagine that you're holding a huge HORSESHOE in front of your abdomen, with the 'open' end downwards, then that'll give you the location of your large bowel.

So, it starts in the lower right-hand corner of your tum.  It then runs up the RIGHT side of your belly, till it reaches the area under your ribs.  Next if goes across the TOP of your abdomen, before turning downwards - and then running straight down the LEFT side of your tummy.  And finally, it finishes up at the anus.

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COMMON BOWEL PROBLEMS

So now let's have a look at the common problems which can affect this organ.  The ones I'm going to deal with are:

*  CONSTIPATION

*  DIARRHOEA

*  IRRITABLE BOWEL SYNDROME

*  DIVERTICULAR DISEASE (diverticulosis)

*  COLITIS  (ulcerative colitis)

*  CROHN'S DISEASE

*  CANCER

And at the end, we'll deal with TESTS for bowel trouble - including the increasingly common COLONOSCOPY.  So here goes ...

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CONSTIPATION

Constipation is. of course, a SYMPTOM - rather than a disease.  It is fantastically common in the over-50s, particularly those who don't get much exercise or who are on a poorly-chosen diet.  But unfortunately many people have trouble getting their GP to take constipation seriously.

Why?  It's because today's doctors are far less interested in 'regularity' than their predecessors used to be.  These days, most general practitioners hold that it doesn't really matter how often you go to the toilet ..

However, the fact is that for a lot of people aged 50-plus, going to the loo fairly regularly DOES matter.  I have seen many patients who become deeply distressed if they don't have a bowel action every morning!

Good tips for beating  constipation are:

*  Eat lots of fibre - including fruit with skins on, and cereals such as Weetabix or All-bran.  Wholemeal bread is good too.

*  Get a reasonable amount of exercise - don't sit around.

DRUGS for constipation aren't too popular with doctors these days - because after a while they make the bowels even more sluggish than they were before.

Please note the WARNING  about sudden, unexplained constipation at the start of this article.

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DIARRHOEA

Diarrhoea is another common symptom.  It can be due to hundreds of different causes, but the most frequent ones are:

*  Infection - by germs picked up in contaminated food or drink

*  Over-use of laxatives

*  Adverse reaction to drugs - notably the 'anti-rheumatic' pills that so many 50-plus people take

*  Irritable bowel syndrome - which we'll deal with in a moment

*  Ulcerative colitis and Crohn's disease - see later in this article

*  Complications of surgery

*  Diabetes and thyroid trouble

If you get prolonged and unexplained diarrhoea, ALWAYS see your doctor about it.

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IRRITABLE BOWEL SYNDROME

This is one of the most frequently encountered disorders of today - and it's a blooming nuisance to a lot of people!

According to some estimates, one in five of the population gets it at some stage of their lives

The cause remains unknown.  Many doctors attribute it to STRESS and TENSION.  But I can't help feeling that one day we shall find some 'bug' which is helping to cause the problem.

MAIN SYMPTOMS of 'IBS' are bloating, abdominal discomfort, excessive wind, bouts of diarrhoea - and sometimes bouts of constipation.  A characteristic feature is that tummy ache and discomfort are relieved by passing a motion - or passing wind.

In this condition, the most important thing is to get yourself checked out by a doctor.  If - having examined you - she tells you that it's only IBS, and not something more serious, that can be very reassuring.  You see, it's quite understandable that many people who suffer from IBS are afraid that they might have cancer.  But IBS has NO connection with cancerous growths.

Unfortunately, TREATMENT of IBS is still rather unsatisfactory.  It's well worth manipulating your diet, to see if taking more fibre helps. (But some people find that they do better on LESS fibre.)  Your doctor has a range of medicines which should give you some relief.

And cheer up!  IBS often disappears of its own accord after a while.  A lot of people have it for a few years - and then it mysteriously vanishes.

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DIVERTICULAR DISEASE

Hundreds of thousands of British people have things called 'DIVERTIULAE' - which are little 'pouches' that develop in the walls of the large bowel.  The cause isn't known. 

Astoundingly, HALF of all over-50s have these tiny pouches.  But in the great majority of cases, there are NO symptoms at all - so the person is completely unaware that he / she has diverticulae.

Unfortunately however, some patients get DIVERTICULITIS - which means the inflammation of these little pouches.  And that DOES tend to cause trouble - in the shape of tummy pain, diarrhoea or constipation, and fever.

Most people who have 'diverticular disease' can be treated with medication and adjustment of diet.  But a small proportion do need surgery.

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COLITIS

'Colitis' means inflammation of the colon - that is , the large bowel.  The common type which is seen in this country is ULCERATIVE COLITIS.

The cause of this condition isn't known yet.  It usually starts when people are in their 20s or 30s.  Symptoms include very severe diarrhoea (with blood and mucus, plus abdominal pain).

Medication with drugs such as sulphasalazine helps, but some patients do need extensive surgery.

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CROHN'S DISEASE

Once again, the cause of this relatively common condition isn't known.  It tends to affect younger adults, rather than older ones - but there is also a small 'peak' among women in their 60s.

The symptoms of Crohn's disease include tummy ache, diarrhoea and weight loss.  Many patients can 'manage' the disease successfully with the help of anti-diarrhoea medicines and other drugs, but the majority of people will eventually require surgery.

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CANCER

It's important to face the fact that bowel cancer is very common - particularly in the over-50s.  Possible symptoms include:

*  Unexplained change in bowel habit

*  Persistent abdominal pain

*  Weight loss

*  Bleeding from the bowel

The GOOD news is that if it's caught early enough, bowel cancer is often cured.  So if you've got symptoms that are worrying you, don't delay:  go to your doctor and get yourself examined.

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BOWEL TESTS - INCLUDING COLONOSCOPY

Lots of people don't understand the tests which are carried out for bowel trouble.  Partly, that's because so many folk find the whole subject rather embarrassing!

But it is a good idea to know what the common tests are - especially if you've got a bit of a bowel problem.  Here's a list:

*  STOOL CULTURE - this means sending a very small portion of bowel motion (in a plastic container) to the lab.  The technicians then see if they can grow any significant germs - such as salmonella - from it.  This test is often done when people come back from holiday with tummy trouble that has failed to clear up.

*  STOOL OCCULT BLOOD - again, this involves sending a tiny amount of bowel motion to the lab.  They test it to see if it contains any blood - since this would probably indicate internal bleeding.

*  SIGMOIDOSCOPY  -  this is an admittedly jolly uncomfortable test in which a specialist pushes a long metal instrument into your bottom, to get a good look at the inside of the lower part of your bowel.  Although it's not much fun, it can be very useful in ruling out serious rectal problems.

*  BARIUM ENEMA - this is the special x-ray in which barium 'dye'  is injected into the rectum in order to outline any abnormalities in the large bowel.  I have to admit that it's not the most dignified of tests to have to undergo- - but it can be a life-saver.

*  COLONOSCOPY - This investigation is being done increasingly often these days.  You go into an operating theatre and a specialist slips a flexible 'telescope' into your rear end- then gently guides it round the entire five feet of your large bowel, as far as your appendix.

This enables him to see absolutely everything inside the bowel.  Very often, if there are 'polyps' (benign swellings) present, he can simply use the instrument to snip them off - and so cure you.

A colonoscopy isn't exactly the world's most agreeable experience, but it too can sometimes be life-saving.  I may as well finish by telling you that I myself had a colonoscopy several years age.  As a doctor I found it simply fascinating to see so deep inside the body!  I still have a souvenir photo which the specialist gave me; mind you, it does look awfully like the snapshot of the Circle line at midnight!

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Q. I have recently had BLACK motions.  Can I safely ignore these?

A. No way!  All adults ought to be aware that black motions usually indicate BLEEDING somewhere inside.  However, this symptom can also be caused by either taking IRON pills or drinking RED WINE.  In any case, see your GP this week.

Q. I'm 61, and have had vague tummy ache for six months, coupled with some bowel disturbances and maybe a little width loss.  Does this matter?

A. Yes.  If you have a look at my articles above, you'll see that these symptoms can sometimes indicate serious diseases of the bowel.  It may be nothing - but you DEFINITELY need a medical examination and tests.

Q.  I own a large firm in Scotland, and most of the workers are over 45.  A doctor wants to treat everybody on my staff for 'hidden blood in the motions.'  Is this a good idea?

A.  Probably, especially as bowel cancer is so very common in Scotland.  The test is the 'Stool Occult Blood' one that I've mentioned above.  There have been a number of successful schemes in which large groups of people have been tested in this way.  But obviously, you must allow staff members to 'opt out' if they're embarrassed about taking part.

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Q. Is there any reason why a man of 72 shouldn't play tennis?

A. None at all.  Obviously, if you take a fall on the court, there's more chance of injury than if you were younger.  But in general tennis is excellent exercise.

Q. Am I correct in thinking that after the age of 65, there is no longer any risk of breast cancer?

A. No ma'am.  Many cases occur in the over-65's.  So please continue to be 'breast aware'.

Q. I take Hormone Replacement Therapy, to try and keep myself young.  In the light of recent alarming news stories, do you think I should go on with it?

A. No, I don't.  In the last year, it has become clear that HRT is far more risky than we thought.  Taking it for a while to keep away the dreaded hot flushes is fine.  But to stay on it long-term in order to try and 'stay young' is risky.  Sorry!

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