Symptoms  |  Talking to your GP  |  What else could it be?

| Common symptoms of bowel cancer cancer include:

  • A recent, persistent change in bowel habit
    Such as looser, more diarrhoea-like poo, constipation, or going to the toilet more often, or trying to go - irregularity in someone whose bowel habits have previously been regular
  • A change in shape or appearance of your poo
    For example, narrower poos than usual or mucus in poo
  • Blood in your poo or rectal bleeding
    Bright red or very dark blood should never be ignored
  • Frequent gas pain, cramps
    A feeling of fullness or bloating in the bowel or rectum
  • Unexplained anaemia
    A low red blood count causing tiredness, weakness or weight loss
  • A feeling that the bowel has not emptied completely after going to the toilet
  • Pain or a lump in the anus or rectum
  • Abdominal pain or swelling
 
Not everyone experiences symptoms, particularly in the early stages of bowel cancer. The above symptoms may be suggestive of bowel cancer, but they can also be due to other medical conditions, some foods or medicines.
 
Don't delay in talking to your GP if you are experiencing any of the described symptoms for two weeks or more, because when diagnosed early almost 99 percent of cases can be successfully treated.
 
Blood in the stool or rectal bleeding should never be ignored. 

Symptoms

Talking to your GP
 
If you have been experiencing any of the symptoms of bowel cancer for two (2) weeks or more, you should make an appointment with your GP.

Some people struggle with working up the courage or finding the time to make this important appointment, and this delay only increases the worry and fear.

Your GP will listen carefully to your concerns. They will encourage you to talk about the symptoms you have been having, including those problems affecting your bottom and your bowel habit. Whatever you have to say, they will encourage and support you to share your concerns with them, so that they can help you.

The more information you can give to your GP about your bowel habit and what has changed recently, the easier it will be for them to make an accurate diagnosis – so don't be shy, and don't put it off.

Your GP has heard it all before.

Before you go to your GP

Before you go to your GP, it might be useful to keep a symptom diary recording what you have been experiencing, and for how long.

It may also be worth printing this webpage, considering your answers to the questions below and take it with you to your appointment.

Alternatively, a list of additional questions to ask your GP can be found on our What I Need to Ask webpage.

At your General Practice

If you go to your GP with a bowel related problem, here is a list of routine questions which your GP should ask as part of your consultation:

  • How recently did you start to notice the symptoms?
  • Have you noticed any bleeding from your bottom? If you have, what did it look like - bright red, dark red - and how much blood was there?
  • Have you noticed looser, more diarrhoea-like stools, and going to the toilet more? Or, are you trying to go and feel that you are constipated, or unable to completely empty your bowel?
  • Is there any family history of bowel cancer, or any other cancer?
  • Have you experienced any unusual abdominal (tummy) pain or lumps?
  • Have you unexpectedly lost weight or become more tired recently?

Your GP should also ask you additional questions on:
  • your lifestyle and diet (to identify any other possible risk factors)
  • your own past medical history
  • any medicines you might be taking (including pain killers, anti-inflammatory medicines, indigestion remedies, antibiotics and laxatives)

Your GP will need to know how your symptoms are affecting your quality of life. This is a particular problem if the work you do makes it very difficult to cope, or if you are having to take time off because of embarrassing problems with changing bowel habit, or if your ability to work is being affected by pain; feeling tired or dizzy or getting short of breath; not being able to eat properly or needing to go to the toilet more frequently.


Examinations and investigations
 
In addition to asking questions about your symptoms, your GP may feel your abdomen for any lumps or tenderness, and may also perform a rectal examination (a gentle examination with a gloved finger to look for and feel for any suspicious lumps in the bottom or rectum).

If your GP does not examine you, you should ask why they have chosen not to.

Your GP may also choose to ask you to have a blood test to see if you have anaemia or anything else that may help with a diagnosis.


What next?

If your GP cannot find any clear cause for your symptoms, you may be asked to watch and wait for a week or so, to see if they settle on their own, or with the treament your GP prescribes to make you more comfortable. The younger you are, the more likely it is that your GP will want to exclude other, simple reasons for your symptoms.

It is very important to be clear about when you should go back to your GP again if the problem(s) you are having do not get better. You should then be referred for further investigations by a specialist.


Guidelines for clinical significant symptoms
 
At any age, if your symptoms include any unexplained signs - blood in your poo, changed bowel habit, anaemia or a lump in your abdomen - you should be referred by your GP for further investigation via colonoscopy within 30 days.

Similarly, you should be referred by your GP for further investigation via colonoscopy within 30 days if you have received a positive screening test result (known as a faecal immunochmical test (FIT)).

The referral doesn't mean you have cancer. Most people with symptoms do not have cancer but it should be ruled out as an underlying cause through further investigations.


Symptoms

What else could it be?
 
There are many common conditions that can affect bowel health and bottoms, with many having symptoms similar to bowel cancer.

Although you might feel embarrassed to talk about them, it is important to get checked out by your GP if you notice anything unusual.

In most cases, the diagnosis will not be bowel cancer, but if you have symptoms and are worried, make an appointment to talk to your GP.

Most people with these symptoms do not have bowel cancer, but it is very important to have further tests to rule it out.

Your symptoms could be caused by other common conditions, that can be treated or controlled by your GP, such as:
If you have symptoms and you are worried, make an appointment and talk to your GP.

 
Anal fissures

An anal fissure is a tear in the skin around the opening of the anus, commonly caused by constipation or trauma to the area.

The main symptom is usually a sudden and severe, sharp pain in or around the anus which can travel up into the back passage (rectum) and last for several seconds.

Fissures can be treated by changes to diet and lifestyle to encourage the healing of the fissure and avoid future constipation.

Creams and ointments can also be prescribed by your GP if necessary.

If symptoms are unexplained or do not resolve on their own, you must discuss your concerns with your GP.

Constipation

Constipation is a very common condition that affects people of all ages.

Poo moves slowly through your system, so more water is reabsorbed. You will open your bowels less often than usual and the poo will be harder, bigger and more difficult to pass, or small hard lumps like rabbit pellets.

You may feel quite bloated, and unwell, passing more wind than usual and perhaps even feeling sick.

As well as not passing poo as frequently as you normally do, you may have to strain to go and it may hurt to pass poo. You may have a feeling that you are unable to totally empty your bowels. Excess wind caused by constipation can cause stomach pains or cramping.


Causes of constipation

Constipation can have many causes, including being physically inactive, a diet low in fibre or not drinking enough water.

Hormonal changes caused by pregnancy, menopause and menstruation can all change normal bowel habit in women.

Constipation can also be caused by some medicines, and by stress.


Treatment for constipation

There are several medications available from your local pharmacist that can help to relieve temporary problems with constipation.

Trying increasing your fluid intake of water and soft drinks (not alcohol or caffeine drinks) to soften the poo and increase bowel activity.

It is important to eat plenty of fibre, found in grains, fruit and vegetables.

If the problem continues for two weeks in spite of increased fluids, improved diet and physical activity, and medication, there may be an underlying problem such as a blockage in your bowel.

You should make an appointment to discuss symptoms with your GP.


Diarrhoea

Diarrhoea is the passing of increased amounts of loose or liquid poo and mucus – often associated with an urgency to go to the toilet.

Most people will experience a bout of diarrhoea at some time.

Diarrhoea causes the body to lose a lot more fluid that normal, and it is very important to increase the amount of water you are drinking, and perhaps consider preparations which will also help to replace lost salts and sugar if the diarrhoea is severe, and especially if it is accompanied by sickness and vomiting.

There are medicines which can help to control the symptoms and you should discuss your individual needs with your GP or pharmacist for short term problems.


Causes of diarrhoea

Causes include infection, food poisoning or a side-effect of a course of medicines e.g. antibiotics (the diarrhoea should stop once the medicines are no longer taken).

Diarrhoea lasting two weeks or more can be a symptom of a number of disorders including irritable bowel syndrome, diverticulitis, Crohn's disease, lactose/gluten intolerance, ulcerative colitis or bowel cancer.

In this case, it is very important that you discuss the problems with your GP.


Diverticular disease

Diverticular disease is a very common condition which occurs due to the ageing of muscles that make up the wall of the large bowel.

Small bulges develop as the internal layer of the bowel pushes outwards through the weakened muscle to form pockets called diverticulae.

In many people, this process causes no problems or symptoms at all, however one in four people will develop symptoms from this condition.


Diverticulitis

The diverticulae (pockets) vary in size, and occasionally small amounts of poo can get trapped in them.

Over time the bowel wall becomes inflamed and this condition is called diverticulitis.

The inflammation can flare up and subside without any medical intervention, however if the diverticulitis becomes more severe, treatment in hospital with antibiotics may be necessary, but this is rare.


Symptoms of diverticular disease:

  • Left sided abdominal pain
  • Constipation/diarrhoea

Prevention of diverticular disease

It is thought that a high-fibre diet can help the large bowel function more efficiently.

Regular light to moderate exercise can also keep your bowel functioning normally.

It is recommended that an otherwise healthy person drinks two to three litres of water over the course of a day.


Treatment and management of diverticular disease

Traditional advice was to eat a high-fibre diet. However, it is now thought that a low-fibre or low-residue diet can ease the symptoms when there is a flare up or suspected inflammation.

This reduces the likelihood of poo brushing against and irritating the affected bowel wall.

Regular doses of paracetamol can be used to relieve pain.

Avoid products containing codeine or opiates, as these cause constipation.

Where you must take these for other painful conditions, your GP may prescribe laxatives to help you open your bowels.


Symptoms of diverticulitis:

  • Feeling generally unwell (flu-like symptoms)
  • High temperature (above 38oC)
  • Shivering
  • Acute tenderness and pain in the abdomen (tummy)
  • Bloating
  • Rectal bleeding
  • Nausea and vomiting
  • Becoming pale and clammy
  • Palpitations, feeling that your heart is beating very fast
  • Generalised weakness and fatigue

If these symptoms develop and you feel acutely unwell, go immediately to your nearest emergency department or call an ambulance.


Is there a link between diverticular disease and bowel cancer?

There is no proven link between bowel cancer and diverticular disease.

Diverticular disease makes the colon more rigid, and this may make the process of diagnosing bowel cancer through colonoscopy more challenging.

If this is the case, another form of test may be used.

If you are experiencing any of the symptoms of diverticular disease for two weeks or more, talk to your GP.

The symptoms of diverticular disease and bowel cancer can be very similar, so symptoms need to be fully investigated before a diagnosis of diverticular disease can be accepted.

Investigations may include bowel imaging, which could be flexible sigmoidoscopy, colonoscopy, CT colonography or a combination of these procedures.

Visit the tests and investigations webpage for more information about these procedures.


Food intolerances and allergies

Food allergy

Food allergies usually cause overt symptoms within a few minutes or up to an hour after eating the suspect food.

They can cause many symptoms such as, a drop in blood pressure, itching skin (hives) or mouth, vomiting, diarrhoea or stomach pain or in severe cases anaphylaxis.

Anaphylaxis is potentially life threatening and affects breathing, although deaths are rare in Australia this is due to timely medical intervention.

The common allergens are wheat (coeliac disease), eggs, cow's milk, peanuts and tree nuts; others may by fish, seafood, sesame and soy.

Sometimes allergies can be outgrown (except wheat and gluten allergies). It is always important to be tested by your GP to confirm diagnosis of food allergens.

Coeliac disease is a true allergy which is not outgrown, where a complete abstinence of wheat and gluten is necessary. Caution is recommended to read labels as many pre-packaged foods contain wheat or gluten.
Food intolerances

Food intolerances usually cause symptoms within 30 minutes and up to two hours, mostly presenting with gastric symptoms such as gas, bloating, cramps, nausea and diarrhoea.

Intolerances can be to fruit sugars, lactose from milk, grain sugars, including wheat and corn, artificial sugars and sugars in beans and other foods.

These are also known as Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAPS).

Food intolerances can also be reactive to naturally occurring and added chemicals in foods.
 
Your GP can test for FODMAP intolerances with a simple breath test. A dietician or nutritionist can assist with other intolerances.
 
Once diagnosed caution is recommended to read labels, as most pre-packaged foods contain sugars, corn syrup, gluten as well as added chemicals.
Food intolerances, allergy and irritable bowel syndrome (IBS) and bowel cancer risk

Food intolerances and allergy are often associated with IBS. Although IBS is not linked to the development of bowel cancer it is best to consult your GP if you have changes in bowel function or persistent IBS symptoms. Very rarely it can mask bowel cancer symptoms
Coeliac disease and bowel cancer risk

Limited studies have identified that coeliac patients who adhered to a gluten free diet did not have an increased risk of bowel cancer, however those who did not adhere to a strict gluten free diet were associated with an increased risk. At this point in research there is little evidence of risk and further studies are required. 

Irritable Bowel Syndrome (IBS)
 
Irritable Bowel Syndrome (IBS) is an increasingly common problem and is usually characterised by a collection of symptoms, which can include stomach pain, diarrhoea and/or constipation.

The causes of IBS are unknown (although food intolerance, infection or bacteria, lifestyle and emotional stress are thought to be linked in some way and may trigger many cases).

Following examination and investigation, it may be that no physical reason can be found for this often vague collection of symptoms, and IBS is the only diagnosis that can be given.

The symptoms can also fluctuate; sometimes you may be really affected on a daily basis, whilst at other times you experience no symptoms at all.

Piles (haemorrhoids)
 
Piles are soft swellings (a bit like spongy varicose veins around the anus).

They are usually caused by some kind of increased pressure e.g. pregnancy, heavy weight lifting, or chronic problems with straining and constipation.

Symptoms of piles

The main symptoms of piles are:

  • Itching or tender lumps around the anus
  • Discomfort or pain when opening bowels / passing poo or afterwards
  • Blood spotting, or bleeding from the back passage which is usually bright red bleeding on the toilet paper
  • A feeling that the bowel is not completely empty after visiting the toilet and opening the bowels
  • A heavy, dragging sensation around the anus

Treatment of piles

Once confirmed as a definite diagnosis, piles do not generally cause serious problems and are safe to leave alone if they're not bothering you.

There are many self-treatment products sold in pharmacies such as creams and suppositories that can help.

You should discuss your needs with your GP or pharmacist.

Bowel cancer can develop whether you have piles or not, so you must seek advice from your GP if the problems get worse or do not respond to the treatment prescribed.
 

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