Possible Explanations? Colon Cancer?

[Geaux]

(No cancer history in parents of)...50 yr. old male, 5'8", 165 lbs. (unchanged in 10 years), non-smoking (smoked 20+ years in past but not for over 5 yrs and recent chest x-ray was very clear), light alcohol daily, has life-long history of single/daily/early-morning/fully-formed bowel movement. For the past 6 months, not a single solid stool; diarrhea each morning (at reg. time); multiple episodes within first hour of waking; includes greatly increased gas ("foul" odor), no blood and little if any stomach pain (occasional lower left quadrant but not daily). Diarrhea also some evenings after meals.



30+ year history of "heartburn," once diagnosed as acid reflux; ELIMINATED symptoms with Prilosec (for three years), but loss of insurance 5 years ago makes post-insurance treatment: 3 Zantac twice daily and several teaspoons baking soda in water when immediate relief required (perhaps 5/wk.). Could the diarrhea be related to the (currently, barely managable) acid reflux?



Also external hemmeroid problem, managable with 2.5% cortisone cream twice/day, several days every other week. Could this be a factor?



Other daily medicines include 5mg. hytrin/day for benign enlarged prostate (last year's annual checkup had negative blood test for prostate cancer(would this have shown colon cancer if present?).



I have a colonoscopy scheduled for next week (after last week's bloodwork showed nothing), but other than the diarrhea, I am healthy in every respect. Continue with sports (tennis, softball, golf) and have no desire to have colonoscopy if one of the above may be causing diarrhea problem, and if confirmation of that could be accomplished by a gastrointerologist, whom I will see for the first and only time at the time of the colonoscopy. Could I perhaps eliminate need for colonoscopy with a a pre-proceedure visit to explain above?



With diarrhea now as "regular" as past solid bowel movement history, I wonder what, other than colon cancer, the colonoscopy MAY find, and how serious this may be.



Thank you for addressing the above. Your site and your service are greatly appreciated.

[Kevin Pho, MD]

Hello - thanks for asking your question.



Diarrhea that persists more than 4 weeks is considered chronic diarrhea.  It makes a viral cause (i.e. viral gastroenteritis) less likely.  



Potention chronic causes includes cancer, inflammatory bowel disease, untreated parasite or bacterial infection, irritable bowel disease or malabsorption.



To answer your questions:



1) External hemorrhoids or acid reflux should not result in chronic diarrhea.  I would investigate a seperate cause.  



2) The negative blood test for prostate cancer (via the PSA - prostate specific antigen) would not have any bearing whether you have colon cancer or not.



3) As you are the age of 50, you should have a colonoscopy regardless of whether you have diarrhea or not.  You are at the age where screening for colon cancer is recommended and the best test we currently have is the colonoscopy.  



4) Other than colon cancer, a colonoscopy can evaluate for colitis, inflammatory bowel disease, polyps or diverticulosis.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

[surgeon]

I think the colonoscopy is a good idea. The symptoms aren't highly suspicious of cancer, but other explanations might be found as well. If not, you may need evaluation for absorption problems.  The hemorrhoids aren't likely the cause of anything...but I'd advise not to keep using hydrocortisone indefinately: it thins the tissues eventually. Try anusol or preparation H cremes.

[tessa0825]

Just to address one statement you made...Please tell the GI Spec. that you have had heartburn for 30 yrs....Long term heartburn can lead to many complications....erosions, strictures, ulcers, hernia (which Im sure you probably already have) barrett's esophagus, even cancer if not controlled....Like you I went in for a scheduled colonoscopy and afterwards when he discovered I had acid-reflux symptoms for 25 yrs, He figured he was checking out the wrong area and scheduled an EGD and found everyone of those complications (except cancer) that I just listed....Good luck.........Tessa

[Sunshine5270]

Just wanted to let you know, this happened to my father-in-law, and it turned out to be a virus. Just wanted to set your mind at ease, all changes in bowel habits are not necessarily cancer.

[Cookiegirl]

If you are going in to check your colon, you might as well have them scope your upper GI as well.  Not a lot of doctors push for that, it seems.  But it's a good idea, and it can be done at exactly the same time, with you being sedated and not bothered by it in the least.  It would provide some good information for your doctors to help profile your entire condition, which I understand is not just involving bowel habits but a long long history of heartburn and taking medication to suppress it.  Heartburn is not always just heartburn.  Scope the upper GI...you could have a tumor or some other condition which is causing some of the symptoms.

[Pamela819]

Hello I have lost my desire to have a bowel movement. I have changed my diet completely and someone said that might be the reason why. I have omitted salt, no added fat, and i'm 99.9% sugar free. I eat 6 small meals aday which breakfast is oatmeal and grapefruit or 2 egg whites and grapefruit. Mid morning, mid afternoon, and evening snack is 2 oz of protein and an apple. Lunch and dinner is 2 oz of protein, 1/2 c carbs, and 1 c veggie.It seems since i've started eating this way my bowel movements have gone out the window. I can go 4 maybe more days without one. When I feel I should have a BM I'll take an herbal tea called Smooth Move at bed time and usually the next morning i'll have a BM, or i've tried a glyserine suspository and i'll have one a few hours later.   Can the way i'm eating affect my bowel movements Really sitting here thinking about it, it started after one day i had like a stomach virus where my tummy hurt really bad. It only last 24 hours and i was fine the next but it seems ever since my BM's have been like this and then I changed my diet soon afterwards.   Can you help or give me somekind of idea what's going on and maybe how to remedy the problem.



thanks Pam