Common Sense v Embarrassment

by K Jones

Ellen looked into the toilet - it was the fourth time that week she had passed blood with a bowel movement. She knew she should go to the doctor, get it checked out - but it was so embarrassing. She decided to wait a while; it was probably just haemorrhoids. It would go away on its own.

She lied to herself for three months. All the while there was more blood and she had started to experience stomach pains and diarrhoea. Worst of all, when she needed to go to the toilet, she really needed to go. It was getting to the stage that she was afraid to leave the house in case she couldn't find a toilet. It had started to interfere with her daily life, so she knew it was time to find out what was going on. She made the appointment.

In the surgery, she blushed and stammered her way through the symptoms.

Doctor Graham listened to her story and tried to reassure her. "It's okay, Ellen, there's nothing to be embarrassed about. Now, I'll check your abdomen, do a rectal exam, just to rule out a few things and we'll do a blood test too."

"Why do you have to do a blood test? What will that tell you?"

"It's just to check for anaemia. How about your appetite - are you eating enough?"

"Yes, I'm eating normally - though I have lost a bit of weight, but I'm sure that's because I'm going to the toilet so often."

The doctor examined Ellen's abdomen and rectum, but she found no haemorrhoids, no blockage and no obvious cause for Ellen's symptoms.

Ellen plucked up the courage to ask the question that had been preying on her mind. "Is it cancer, doctor?"

"I can understand your fears, Ellen, but from the symptoms you've described I think it's most likely either Ulcerative Colitis or Crohn's Disease. I'll refer you to a specialist and he'll do a couple of tests. Does that sound okay?"

Ellen agreed. Soon she would find out what was causing her problems and, hopefully, get better.

Her appointment with the specialist wasn't quite what she had expected. She thought he would just ask her a few more questions, but he had other ideas. He did ask her about her symptoms, her diet, her general health and family medical history. Then he told her about the tests he could do to establish what was wrong.

"Right, Ellen, what we have to do is take a look at the bowel. I can do a procedure today, it's called a sigmoidoscopy. The sigmoidoscope is like a kind of small telescope, a tube that I'll pass into the anus and along the first part of the bowel. I'll be able to see if there's anything obviously wrong and I'll take a biopsy. It's not painful, a bit uncomfortable - but it would mean we could get some results fairly quickly. Would that be okay with you?"

Today? She wasn't prepared for that, and she didn't like the sound of this sigi-thing. "Will I be sedated?"

"No, not for this one. There are other tests, the flexible sigmoidoscopy where we use a longer tube that goes further into the intestine, or the colonoscopy where the tube can go all the way around the intestine - but both of those require preparations for a few days before hand and you would come in as a day patient and receive a mild sedative. That would mean waiting for day patient appointments - and I know you're anxious to know what's going on."

Ellen nodded. "Okay." All she could think was, "Thank God I had a shower and put on decent underwear."

A nurse came into the room and asked Ellen to remove her trousers and underwear and lie on her left side on the bed with her knees tucked up to her chest - since her own doctor had already performed a rectal exam, she was already familiar with this position.

But this wasn't her own doctor. More embarrassment. Was this her butt's best side, she wondered? The consultant chatted to her, trying to take her mind off what he had to do. She tensed when he first inserted the tube, but soon relaxed. It was uncomfortable, but not painful, just like he'd said.

"Okay, Ellen, I'm going to pass some air through the tube, it helps us get a clearer view. It might feel a bit strange and you'll probably have tummy pains later until you manage to pass the air."

It did feel weird; like someone was pumping her abdomen up like a balloon.

"Now, I'll just take a couple of samples for biopsy."

She didn't feel him taking the biopsy samples at all. It was all over in a few minutes. She dressed and went back to sit opposite the consultant.

"I'll get these samples sent away and we'll see if they confirm what I suspect."

Her heart sank a little. "What you suspect? So you could see something wrong?"

"The intestine is inflamed, which leads me to think it's Ulcerative Colitis."

"Is that a serious condition?"

"It's a chronic condition but most people find that the symptoms are manageable with oral medication or enemas - or sometimes a combination of both. In some cases, where the disease is very advanced, we have to consider surgery - but we'll discuss what we do next when I have the results of the biopsy. Ellen, the important thing is that you've had the sense to come and get this checked out. We'll know soon enough how best to treat you."

Ellen read up on the conditions the consultant had mentioned - it did seem that, for the most part, they could be treated quite successfully.

Her results confirmed the consultant's suspicions; she had Ulcerative Colitis. He explained that it meant the large intestine had become inflamed causing ulcers on the intestine which sometimes bleed. She was prescribed oral mesalazine, which belongs to a group of medicines called aminosalicylates, and a steroid foam enema. She hated using the enema, but persevered with the treatment - anything was better than the way she had been feeling.

Within a few weeks she noticed an improvement in her condition. The blood lessened, the feelings of 'urgency' to get to a toilet decreased and the stomach pains all but disappeared.

Ellen knew she wasn't cured - there is no cure for Ulcerative Colitis - and that she would have to be monitored carefully by her doctor and her consultant. At some point in the future she would probably have to undergo the other procedures the consultant had mentioned, just to keep a check on things - but she was glad she had plucked up the courage to go to the doctor.

Slowly but surely, she was getting her health and her life back - that was worth a few minutes of embarrassment and discomfort.