Cancer treatment has improved enormously over the last 25 years and new surgical techniques, drugs and radiotherapy techniques are emerging every year. We now have millions of people who have survived cancer and survival rates for many cancers have increased. The problem is that people who have beaten cancer often face continuing problems because of the impact of their cancer treatment.
Dr Ana Wilson specialises in helping people who have had cancer treatments to the pelvic area or the abdomen and who then develop functional problems such as diarrhoea, urgency, faecal incontinence and abdominal pain.
Bowel function problems after cancer treatment
Gastrointestinal problems are experienced by about 10% of all cancer patients but people who have been treated for the following cancers, either with surgery, radiotherapy, chemotherapy or a combination of these, are more likely to experience bowel function problems:
- Women treated for cervical cancer
- Men treated for prostate cancer
- Men and women treated for rectal, anal or lower bowel cancer
The problems arise when nerves or muscles are damaged by the cancer treatment, which may need to be extensive to remove or slow the growth of the tumour.
The symptoms are similar to those of other functional bowel disorders such as irritable bowel syndrome, but there is a physical cause and the symptoms tend to be much more severe. Common experiences include:
- Constant abdominal pain
- Uncontrolled flatulence
- Diarrhoea that is frequent but unpredictable
- Faecal incontinence, including at night
- A feeling of urgency; the need to defaecate is uncontrollable and the person needs to get to a toilet within minutes to prevent an accident
- Blood and/or mucus in the stools
These symptoms can be long-lasting and cause extreme distress. They also prevent people going back to work, so creating financial hardship and are likely to lead to people becoming isolated. Fear of having an accident prevents them socialising with family and friends and many people feel confined to their own homes and may need to buy pads and other incontinence supplies. Relationships can also become strained, particularly if a partner or other family members need to wash and change the person who is incontinent.
The most important thing to realise is that many things can be done to ease symptoms and improve bowel function in the long-term. Diarrhoea can be due to an infection in the small or large bowel; this may have arisen due to the damage caused by cancer treatment but it can be investigated and treated. The cause of bleeding can be investigated and treated and it is also possible to follow a programme of pelvic floor exercises to improve control.
The symptoms themselves are not good pointers to the underlying problem so it is important to use endoscopic methods to find out the exact cause so that specific treatments can be started.
The following diagnostic tests are available from Dr Ana Wilson:
- Flexible sigmoidoscopy
- Endoscopy of the upper digestive system
- A check of your vitamin B12 levels
- A check for thyroid function
- A breath test to measure glucose metabolism
- Screening for coeliac disease
- Screening for bacterial overgrowth
- Screening for infection
Treatment is available for:
- Bile acid malabsorption
- Infection (viral, bacterial, fungal)
- Bacterial overgrowth
- Malabsorption of carbohydrates
- Malabsorption of fats
- Pancreatic insufficiency
- Disruptions to endocrine hormone levels
- Short bowel syndrome
- Inflammatory bowel disease (arising after cancer treatment)
- Ulceration of the bowel wall
The form of the treatment may involve a combination of very different methods. Dr Wilson will explain which treatments she recommends and why, and the likely impact on your condition in the short-term as well as the long-term. You will also have access to support from a nutritionist and the opportunity to adopt dietary and other lifestyle changes that can help.