A peek in the bowl can be good for your bowel. Dietitian Brooke Longfield lifts the lid on this important topic.
We all have them every day, yet the very mention of bowel movements makes most of us squirm with embarrassment. Although few are comfortable talking poo, being coy can stop you from being frank with your doctor, leaving you in the dark about bowel cancer — yet it’s a disease with which you should be familiar, whatever your age or sex.
“Forget the notion that bowel cancer only happens to old men,” says Julien Wiggins, CEO of Bowel Cancer Australia. In fact, among young people, the incidence of this disease has actually doubled over the past 20 years. Why? As Wiggins explains, “Increasingly unhealthy Western diets and numerous hours spent sitting (rather than moving) are two of the reasons rates are climbing.”
Bowel cancer is Australia’s second most deadly cancer after lung cancer and before prostate cancer. This means about one in 12 of us will develop this disease. Fortunately, bowel cancer is highly preventable and, if caught early, often treatable. We’ve answered some common questions to help you spot the signs and give your bowel the best care.
“As a woman in my 30s, I’m surely not at risk — or am I?”
“‘You have bowel cancer’ are four words you never expect to hear when you’re young — but the reality is that you’re never too young,” says Wiggins.
“Although the risk increases dramatically from the age of 50, bowel cancer can develop at any age, and it’s usually more aggressive when you’re young. This makes it even more important to speak to your doctor if you feel that something is wrong.”
“What are the warning signs?”
The early stages of bowel cancer tend to cause very few symptoms, making it difficult to detect. This means you need to recognise the early warning signs, because the sooner you catch it, the higher your chances of successful treatment. Take a peek at the porcelain before you flush, and listen carefully to your body.
Women tend to be in tune with their bodies, but men, especially young men, are likely to ignore early signs of the disease. We should all be aware of these common symptoms:
Blood in the stools; changes in your bowel habits, including frequency, diarrhoea or constipation; or pain when you go.
Bloating or a feeling of fullness in the bowel can be an early warning sign, as can frequent bouts of gas or cramps. Some people mistakenly attribute these uncomfortable symptoms to irritable bowel syndrome (IBS).
Pain in the abdomen, rectum or anus is another early symptom, along with unexplained anaemia, fatigue or unexplained weight loss, or a combination of all three. (Haemorrhoids can also cause anal or rectal pain.)
Having one or more of these symptoms doesn’t necessarily mean you have cancer, but if any of them persist for more than two weeks, see your doctor promptly for further investigation.
“My dad had bowel cancer. Does that increase my risk?”
Family history plays a part in approximately 25 per cent of bowel cancer cases. In general, the more family members who have (or have had) the disease and the younger they were when diagnosed, the greater your risk of developing it.
Find out if your parents (or their parents, or their parents’ parents) were ever diagnosed with bowel cancer, or with any other health condition that may have a genetic link.
“I saw a little blood in my stool. Should I be worried?”
Seeing bloody or tarry stools in the toilet bowl is alarming, but these can be due to a number of causes, and they don’t all point to cancer.
The first step is to see your doctor, not dodgy Dr Google. Though discussing your bowel motions can be a little discomfiting, a proper diagnosis is essential — you can’t just flush the problem away! Your doctor will take a detailed medical history and may do some blood tests or a rectal examination to feel for abnormalities. From there, he or she will decide whether you need a colonoscopy.
“What are polyps? Can they cause cancer?”
As we age, our large intestine can develop polyps — small, sometimes mushroom-like growths that protrude from the lining of the colon or rectum.
Experts don’t yet know why polyps develop, but we do know that they’re particularly common in people over the age of 50, and even more so if those people smoke or carry excess weight. Most polyps have no symptoms and are usually harmless; however, most bowel cancers develop from these tiny lumps over time. This means you should have any polyps removed to reduce your risk of this disease.
“What does a check-up involve?”
If you notice any potential symptoms, make an appointment with your doctor as soon as possible.
Of course, bowel cancer can develop without any early warning signs, so the Australian Government provides the free National Bowel Cancer Screening Program. Every Aussie receives a free screening kit upon turning 50, and another every five years after that. By 2020, this free test will be available every two years, in line with current medical guidelines.
Meanwhile, if bowel cancer runs in your family, you should test yourself every one to two years. You can buy an at-home kit from a doctor or pharmacy.
“How does the at-home test work?”
The growth of bowel polyps or tumours can take years, during which they sometimes leak small amounts of blood, long before any other symptoms develop. Such trace amounts are invisible, so naturally we don’t notice them.
The screening test enables you to take a stool sample no larger than a grain of rice, put it in a tube and post it to a lab. Pathologists can then detect any blood, which will help determine your cancer risk. Unfortunately, only about one in three people who receives the screening kit bothers to take the test and send it off for analysis.
“Lots of people still consider bowel cancer screening messy and embarrassing,” says Wiggins, “but it’s incredibly effective and doesn’t require a physical exam.” A positive test result doesn’t necessarily mean you have bowel cancer, but it is a sign that you should have further medical investigation. A colonoscopy allows doctors to examine your intestinal lining for precancerous polyps, which they can then easily remove.
“Once a polyp is gone, it can never grow into cancer,” says Wiggins. “This reduces your risk of developing the disease.”
“I’ve heard that some foods can reduce my risk. What dietary changes should I make?”
Yes, eating the right foods can help lower your risk of bowel cancer by up to 75 per cent.
The World Cancer Research Fund (WCRF) recommends we eat a balanced diet, which means following general healthy-eating guidelines. Read on for what to eat and what to avoid.
Fruit and vegetables — because they provide protective cancer-fighting antioxidants, and they’re high in fibre, vitamins and minerals for optimal health.
Fill half your dinner plate with non-starchy vegetables, such as carrots, capsicums, tomatoes and leafy greens. (Potato and corn are examples of starchy vegies.)
Whole grains — because they protect against bowel cancer in several ways. Fibre not only adds bulk to stools and guards against constipation, but also promotes the growth of healthy bacteria in the bowel. We should all aim to consume 30g of fibre a day, but increasing your daily intake by just 10g produces a 10 per cent drop in your bowel cancer risk.
Eat high-fibre whole grains, such as oats, bran, brown rice and wholemeal pasta.
Legumes — because studies link their fibre and protective phytochemicals with a lower risk of bowel cancer. Many Aussie diets are low in lentils, beans and chickpeas, so add these foods to more of your meals.
To save prep time, look for no-added-salt canned varieties, which can replace meat in soups, stews and even bolognese.
Garlic — because “there’s evidence from around the world that eating one clove of fresh garlic a day is protective against bowel cancer”, explains Teresa Mitchell-Paterson, nutritionist at Bowel Cancer Australia.
The positive effects of this pungent plant are largely due to its antibacterial properties.
Calcium — because studies link a high calcium intake with a 22 per cent reduction in bowel cancer risk. Aim to eat three daily serves of dairy, such as a glass of milk, a 40g piece of reduced-fat cheese and a small tub of yoghurt. Other research shows that people who drink 200ml of milk a day enjoy a 9 per cent lower risk compared with those who don’t.
Red and processed meats — because mounting evidence links bowel cancer with a diet high in these foods, particularly deli meats. Studies show that for every 50g of ham, bacon or any other processed meat you eat each day, your bowel cancer risk rises by 18 per cent. Save these meats for special occasions or avoid them altogether.
Red meat can stay on the menu as long as you keep serves to 100g of raw meat, a portion about the size and thickness of your palm. “Aim to eat red meat only two to three nights a week and limit your overall weekly intake to under 500g. Try to include more fish- and plant-based meals, like vegetable soup,” says Mitchell-Paterson. “If you’re used to eating 250 to 300g steaks, there isn’t much room [after one meal] for more meat in your weekly diet,” she adds.
Our beloved barbecue steaks and snags can also ramp up our cancer risk, because charred meats can damage the cells that line the bowel. Marinate meat to reduce harmful chemicals that result from charring, keep cooking temperatures low when possible and avoid cooking over open flames to prevent burning.
Alcohol — because evidence links long-term drinking with a heightened risk of bowel cancer, especially in men. Women aren’t entirely off the hook though, as the link is probable. Men should cap their daily consumption at two standard drinks, women at one, and both sexes should have at least two alcohol-free days every week.
Don’t be a sitting duck
Most of us lead busy lives, so we have to make time for exercise. But even the odd walk or game of tennis on weekends won’t undo the damage caused by sitting for long hours during the week.
Think about it — the hours quickly add up when you sit all day at work and couch-surf all night. A recent US study shows that men who sit for more than 11 hours a day have a much higher risk of bowel-tumour recurrence than men who sit for fewer than seven hours do.
If you have a sedentary job, think of ways to include more incidental activity in your day. Doing something is better than doing nothing, so park your car farther from work, go for a walk before you eat lunch and stand up to take phone calls.
Did you know? Bowel cancer rates in Australians under the age of 30 have doubled over the past two decades.
Too many Aussies have bowel cancer. Why? Most of us eat a lot of red meat and not enough veg.