Frequently Asked Questions

Some frequently asked questions (FAQs)

Someone I know has symptoms I think sound serious. Can I use this symptoms checker on their behalf?

You certainly can as it is only necessary to know the answer to a small number of simple questions to determine whether they should see their GP. Even if then the chance of them having a serious condition is likely to be very small but that it is worth them having a simple examination and perhaps blood test to see if they can try further simple treatments while their symptoms settle.

What is a PR examination?

This is an examination of the back passage which although unpleasant only takes a few minutes and doesn’t usually cause too much discomfort. Your GP usually will ask you to lie on your left side and will pass a gloved finger lubricated with a clear jelly like material a short distance through the anal canal into the rectum.

PR stands for Per Rectum

I’ve heard you can get a perforated bowel from having a colonsocopy is that true?

There is almost no test that you can have which is completely without a risk which is why it is important that you only have tests like colonoscopy when there is some real benefit. You should never have a test on the basis that you have nothing to lose by having it! Most tests are advised on the basis that its potential benefit is greater than its risks. However the risk of bowel perforation colonoscopy is very small and mainly occurs when a polyp is removed by passing an electric current through a wire to cut its stalk while making sure it doesn’t bleed. Most people having colonoscopy don’t have any polyps and in these patients the risk of perforation is very small.
If your Doctor offers you a colonoscopy ask what the benefit is and if it is being done ‘just to make sure’ it is perfectly reasonable to ask whether it is worth waiting a little longer to see if your symptoms settle. There are also alternative tests which are worth asking about such as a CT scan.

However don’t forget it is sometimes safer to watch and wait a little rather than to take an immediate decision about having further tests.

Does a colonoscopy hurt?

Colonoscopy can be quite uncomfortable but you are usually given some sedation as well as an injection to make it more comfortable. The injections sometimes make you feel you have been asleep through the whole procedure and you don’t remember having it! People do vary and if your bowel doesn’t have too many bends there is a good chance you will have no discomfort at all.
However it is important that you have a complete examination and this can take some time particularly if there are a lot of bends in your bowel and more air needs to be put into the bowel. This can cause a little colic.

Can I still have my colonoscopy if I don’t take the preparation liquid?

No! If you have trouble taking the preparation you should let your surgery and the hospital know as soon as possible. It might be possible for a small number of patients to have an alternative test with the same appointment but most will have to re-book it perhaps with help from your surgery’s community nurses.

Is a flexible sigmoidoscopy enough?

It depends on the nature of your symptoms and your age. However there is no test that can reduce your risk of having a serious condition to zero and in some patients a normal flexible sigmoidoscopy may mean you are at such a low risk that the person doing the examination, if he or she is older than you will be at higher than you are! If the doctor says you don’t need a further test then it is well worth watching and waiting to see if your symptoms disappear in which case it will have enabled you to avoid another test which may be slightly risky and at best will mean more time off work and may be uncomfortable. However if our symptoms persist let your Doctor know as it may be necessary to have the next test.

How can I find out if my family history is strong?

The best way is to see a genetics counsellor but there are some simple rules which may reassure you. In bowel cancer your lifetime risk is not greatly affected unless a ‘first degree’ relative; mother, father, brother or sister has had bowel cancer below the age of 45years. This will double your risk of having bowel cancer but will still mean you have an over 90% chance of not getting it.This means if you have a grandparent or aunt, uncle or cousin with bowel cancer, particularly if they were over 60 years of age your risk of having bowel cancer will be no greater than people without a family history. The NHS only advise people to have screening if they have a first degree relative who developed bowel cancer when they were aged 45years or below and that they should then start having screening when they are 5years older than the age at which the relative presented with bowel cancer. For example if the relative was 40 years old when getting bowel cancer the first degree relative should start having screening when they are 35years old.

If you very concerned about this you should see your GP as these matters are difficult to understand.

How long should I expect to wait for my referral appointment to come through?

This depends on how your GP has booked it. It could be as soon as 2 weeks but more likely to be 4-6 weeks. However no matter when your appointment is you should be informed of the date within 1-2 weeks of seeing your GP and if you haven’t heard by then you should either contact the hospital directly of phone your surgery and ask them to check a request for an appointment has been made and when you will hear about a date for this.

What are laxatives, how do they work and when should I use them

Laxatives are tablets, pills or liquids, which help your bowels to work on a regular basis They should be used if you are passing harder, drier stools less often and dietary methods haven’t worked They work in five ways, some may work in more than on way

There are laxatives which:

1. Soften the motion such as lactulose

2. Lubricate the motion such as liquid paraffin

3. Increase the bulk of the motion such as fybogel

4. Stimulate the bowel to contract and push the motions around the bowel such as senekot

5. Draw water into the bowel and soften the motions. “Salts” such as magnesium hydroxide do this. If you also have indigestion, it is a good idea to take magnesium hydroxide (salts) rather than aluminium hydroxide which tends to constipate the stool.

When you select a laxative, ask your pharmacist how it works. The most gentle is the lactulose type. Other laxatives may be powerfuland may have more side effects as you progress to the stimulant laxatives such as senekot. However all these medicines are very safe to take if you are otherwise fit but it is always a good idea to discuss this with the pharmacist if you have any worries
The laxatives in groups 4 and 5 always work if you take enough of them, although in the larger doses they can cause bowel spasms, colic
and diarrhoea, which may be difficult to control, particularly in the elderly and can result in incontinence.

How should I clean my bottom

Soreness and itching around the bottom can be due to increased sensitivity of the skin to motions and it is then necessary to be over careful to make sure the skin is gently and completely cleaned.

Careful cleaning

First ‘wet wipe’

1. Use toilet paper moistened with warm (not hot) tap water to clean yourself after having your bowels open

2. After wetting the paper and before cleaning, gently pass the paper over a bar of soap. This stops the paper breaking up into small pieces and allows the paper to slide over the skin around the anus in a gentler manner

3. Strain or push down gently as you wipe your bottom. The warmth from the water allows the muscles around the anus to relax which, together with pushing down, helps you to clean higher up the anal canal and clean the area which may be causing most of the symptoms. You can easily miss this area with normal cleaning

4. Keep wiping until the toilet paper remains clean.

Last ‘dry wipe’

5. Finally dry the area with dry toilet paper making sure that bits of paper are not left on the skin

If the soreness and itching occurs at other times when you have not been to the toilet you can still use this careful cleaning method. This is more likely to happen in people whose main symptom is itching and it is helpful to clean the area around the back passage or anal canal before you go to bed at night

If you pass wind or fart, you can cause little leaks of poo or stool. Check and clean again

Finally it might be difficult to follow this method if you are not at home! Almost as good but more expensive – use wet wipes. Try the very simple ‘aqueous’ wipes you can buy from a supermarket. It is better not to use baby wipes or any others which include additives which could make things worse by causing an allergy

After careful cleaning, there should be no coloured stains on the paper and your bottom should be dry. If cleaning is done correctly, it should stop ‘tram-lining’ of your pants!