There are many digestive diseases, infections and conditions which can affect the normal function of your bowel, and the control you have over it. They often have similar symptoms, characterised by a change in your bowel movements. Pelvic pain often accompanies bowel problems, usually localised to the abdomen and rectum.
The following conditions affect a large population of people around the world. Often, due to the intimate nature of bowel problems, treatment is not sought early and people suffer for longer than they need to. To avoid any permanent damage occurring to your digestive system, it is important that you understand the different symptoms of bowel problems and the early warning signs that you are suffering from something more serious.
- Bowel cancer includes colon (80%) and rectal cancer (20%). It is one of the most common types, often diagnosed in over 60's. If caught early it can be cured by surgery to remove the cancerous tissue and part of the bowel. However if it advances, it can spread and affect other organs which will also require treatment. The difference between bowel cancer and other conditions, is that the symptoms are persistent and cannot be cured by over the counter treatments.
- Bowel infections (gastrointestinal infections) are caused by microorganisms which make their way into your digestive system and into the bowel. They are common in young children and places where there is poor hygiene and people are living closely together, such as in care homes. Symptoms include diarrhoea and nausea, which can further spread the infection. If you frequently suffer from these symptoms, speak to your doctor to ensure you are not suffering from another more serious bowel condition.
- Chronic constipation (faecal impaction) is when a large amount of dry, hard stool is stuck in the rectum. This often leads to overflow diarrhoea, where your bowel produces liquid in an attempt to loosen the stool. This can be hard to control and often results in you soiling yourself, with little relief from the constipation. Chronic constipation can be a result of another digestive disease, or a side effect of a prescribed drug.
- Crohn's disease is an inflammatory bowel disease that affects the entire digestive system from the mouth to the anus. There is no cure currently available, the condition must be managed to get relief from the symptoms. There will be periods of activity when the symptoms flare up and are harder to manage. The disease usually develops between ages 10-30, and again 60-80, with no obvious cause.
- Coeliac disease is an autoimmune condition where the small intestine becomes inflamed as a reaction to gluten. It is therefore unable to absorb nutrients from food, leading to further issues such as fatigue, anaemia and even osteoporosis (weak bones) if not managed correctly. Moderate and severe symptoms effect at least 1 in every 100 people in the UK, most of which are women.
- Diverticulosis (diverticular disease) is when small pockets, or bulges, (diverticula) protrude from the lining of the large intestine. These can become inflamed or infected, leading to acute diverticulitis. The condition is most common in older people, with 70% of people suffering from diverticula before they turn 80. Less than 1/4 of sufferers will experience symptoms, and even fewer will develop complications such as abscesses or intestinal narrowing. Diverticulosis can therefore be lived with if managed correctly.
- Ulcerative colitis is the most common inflammatory bowel disease. It affects 1 in 420 people in the UK, first occurring between 15 and 25 years old. The bowl and rectum become inflamed in response to an autoimmune reaction. This leads to small ulcers developing along the lower part of the digestive system. The inflammation can be consistent or, if well managed, can be subdued unless a flare-up occurs.
Other bowel conditions which can lead to pelvic pain include:
- Irritable bowel syndrome (IBS) - A lifelong intestinal disorder that prevents the large bowel functioning correctly, resulting in abnormal bowel movements which are often uncomfortable and occasionally painful.
- Pelvic floor dyssynergia
- Faecal and flatus bowel incontinence - Leaking wind, and even faeces, is common after childbirth as your pelvic floor will be significantly weakened.
- Rectal prolapse - Prolapse of the rectum out of the anus.
- Rectocele - Prolapse of the rectum into the vagina.
- Enterocele - Small bowel (small intestine) prolapse into the vagina.
If you are suffering from pelvic pain, speak to your doctor to determine whether it is the result of a bowel problem. During your diagnosis you may have a colonoscopy; a thin tube with a camera at the end (a colonoscope) inserted into your bowel through your anus. You may also, or instead of a colonoscopy, have a CT scan.
What are the Symptoms of Bowel Problems?
As with most conditions, the severity of symptoms is connected to the progression of the condition. In the early stages of developing a bowel problem, you may notice very little out of the ordinary. The severity of symptoms may also fluctuate depending on any medications or lifestyle changes you are making.
The symptoms of bowel problems can be categorised into gastrointestinal and non-gastrointestinal symptoms. Gastrointestinal symptoms relate to the stomach and intestines, non-gastrointestinal symptoms can relate to your general health and mental condition. The most common symptoms to be present are shown below. Please note, this is not a comprehensive list and should not be used as a diagnostic tool.
- Anal bleeding and blood in stool
- Abdominal pain, bloating and wind
- Change in bowel habit - especially a need to frequently empty your bowels
- Loss of appetite and otherwise unexplained weight loss
- Tiredness and fatigue
- Mouth ulcers
- Red and swollen skin that is painful to touch
- Irritated and red eyes
- Issues with conceiving
- Nerve damage in the extremities (hands, feet and arms)
What Causes Bowel Problems?
Looking after your digestive system, by eating a healthy and varied diet, can reduce your risk of developing a bowel condition. However, some bowel problems have no definitive cause and can be down to genetic chance.
- Bowel cancer - Cancer occurs where cells begin to grow abnormally, and develop into solid tumours. If malignant, the cancer can grow and spread, affecting other organs and tissue.
- Most cases of bowel cancer occurs in those over 60 years old.
- A diet low in fibre and high in red and processed meats increases your risk.
- Being overweight or obese increases your risk.
- Having an inactive lifestyle increases your risk.
- Both alcohol and smoking increase your risk.
- Your risk of developing bowel cancer is higher if a close relative also has bowel cancer.
- Bowel diseases, such as Crohn's disease and ulcerative colitis, can cause damage to the bowel. Leaving you more susceptible to developing bowel cancer.
- Bowel infections - There are many viruses, bacteria and parasites that can lead to a bowel infection. It is easy to catch them if you come into contact with them directly through a contaminated person or contaminated object, or if you consume contaminated food or water.
- Viruses - Rotavirus and norovirus are both common in young children and the elderly in care homes as they spread easily through vomit and faeces.
- Bacteria - Salmonella is easily contracted from contaminated meat and eggs.
- Parasites - Giardia and amoebiasis are spread through contaminated food and people.
- Chronic constipation - An inability to empty your bowels.
- Constipation is a side effect of some painkilling medicines.
- Having an inactive lifestyle increases your risk.
- Having a diet low in fibre increases your risk.
- Long term use of laxatives increases your risk.
- Stress, depression and anxiety increase your risk.
- Crohn's disease - An inflammatory bowel disease that affects the entire digestive system from the mouth to the anus.
- There is no agreed cause.
- However, you have a higher risk of developing Crohn's disease if a close family member suffers.
- Your risk of developing Crohn's disease increases with smoking.
- Coeliac disease - An autoimmune condition, where the body attacks the digestive system when you eat gluten; any product with wheat, barley or rye in.
- Coeliac disease is NOT an allergy or intolerance to gluten.
- 10% of individuals have a first-degree family member that also suffers, as it is passed through genetics.
- You may develop coeliac if your digestive system has been damaged by previous infections.
- Studies suggest that babies, under 6 months old, should not have gluten introduced with their diet, and should be breastfed (where possible) when gluten is first introduced.
- You have a higher risk of developing coeliac disease if you suffer from type 1 diabetes, Down's syndrome and Turner syndrome.
- Diverticular disease and diverticulitis - The most common cause of diverticular disease is age. As you get older, your organs and muscles weaken. Your large intestine may no longer be able to cope with the pressure of hard stools.
- If you don't eat enough fibre, you will have harder stools more often.
- Ulcerative colitis - Believed to be an autoimmune reaction where the bodies immune system attacks harmless bacteria inside the colon.
- There is no known cause.
- It is believed to be influenced by genetics and environmental factors such as diet.
To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.
How to Treat Bowel Problems
The treatment for your pelvic pain depends on which bowel problem causes it.
- Bowel cancer - Once you have been diagnosed with bowel cancer, you should seek treatment straight away. Depending on how advanced it is, depends on whether it can be cured.
- Chemotherapy - Medication is used to kill the cancer cells.
- Radiotherapy - Radiation kills the cancer cells.
- Surgery - Usually a keyhole surgery to remove the cancerous bowel and tissue. Often an effective way of curing non-advanced bowel cancer.
- Biological treatments - These treatments prevent the cancer spreading, and aim to increase the effectiveness of chemotherapy.
- Bowel infections - Bowel infections often clear up after a few days as your body's immune response takes over. There are over the counter medicines available to speed up your recovery and reduce the symptoms.
- Diet and nutrition - Drink plenty of water and ensure any food you are eating is not contaminated.
- Oral rehydration drinks - To avoid dehydration, available from a pharmacist.
- Antibiotics - If your symptoms persist, speak to your doctor who may prescribe antibiotics to help your body defend itself against certain, more persistent, parasites and bacteria.
- Chronic constipation - To treat constipation, the impacted faeces needs to be removed. If this is a recent change in your bowel habit, speak to your doctor before treating yourself as over the counter laxatives can cause severe cramping as they attempt to stimulate the bowel. This can result in damage.
- Enema - To soften the stool by adding liquid directly into the anus.
- Suppositories - In the same way as an enema, the aim is to soften the stool. A rectal suppository is a solid medicine that dissolves into the rectum.
- Review medication - Never stop taking a prescribed medicine without first speaking to your doctor. Some medications can cause constipation as a side effect.
- Diet and nutrition - To avoid the constipation returning, increase your fibre and water intake.
Exercise - Regular exercise can keep you in a bowel routine.
- Toilet routine - To avoid further discomfort, it can help to be consistent in your visits to the bathroom. Try spending 10-20 minutes on the toilet after dinner each day.
- Crohn's disease - Crohn's disease cannot be cured. Treatment aims to maintain 'remission' where the symptoms are reduced to an acceptable level. In young individuals, treatment also aims to promote growth and brain development. If the disease is having a flare-up, the drug or surgery offered will depend on the state of your condition and its history.
- Steroids - Prednisolone, methylprednisolone or hydrocortisone are often prescribed as tablets or injections to reduce inflammation. Side effects include reduced growth and development, therefore steroids are not always suitable for young children.
- Diet and nutrition - A liquid diet, which contains all required nutrients, can be introduced where steroids are not favoured.
- Immunosuppressive drugs - Azathioprine, mercaptopurine and methotrexate lower the bodies immune system. These drugs make you vulnerable to other conditions, and are therefore are only available to those that have had 2 or more periods of active Crohn's disease within a year, or if a high dose of steroids is otherwise needed to suppress your symptoms.
Drugs to suppress TNF alpha - TNF alpha is involved in gut inflammation, and there is more of it in sufferers of Crohn's disease. Infliximab (for children) and adalimumab (for adults) reduce the levels of TNF alpha.
- Surgery to remove part of the distal ileum - If the disease is affecting only the distal ileum, the last part of the small intestine, you can have the affected part removed. This is usually only available if you have not responded well to drug treatment.
- Surgery to widen intestine - Some cases of Crohn's disease result in narrowing of the intestine. A keyhole surgery can access the affected part, inserting a balloon which is then inflated to stretch the intestine back to normal width.
- Coeliac disease - Coeliac disease cannot be cured, but its flare-ups should be reduced as much as possible to prevent any long-term damage. Treatment can be completed at home.
- Diet and nutrition - Remove gluten from your diet whilst ensuring it is healthy and balanced with no nutrient deficiencies. This may include supplements of calcium and vitamin D which are often lacking in sufferers of coeliac disease.
- Support - Advice and information is available from your GP, as to which foods are best to maintain a healthy diet. You may be referred to a dietitian or nutritionist.
- Diverticulosis (diverticular disease) and acute diverticulitis - Most uncomplicated forms of the condition can be managed at home. If you have suspected complications, then you may be admitted to hospital for treatment.
- Diet and nutrition - Treatments as simple as eating a diet high in fibre may ease your symptoms. If your symptoms are at their worst, your GP may ask you to stick to a fluid-only diet for a few days before making any changes to your diet.
- Physical activity - Keeping active can reduce your symptoms.
- Bulk-forming laxative - A prescribed bulk-forming laxative can help resolve any constipation or diarrhoea.
- Painkillers (analgesics) - Such as paracetamol, can reduce any pain associated with the symptoms.
- Antibiotics - Once your symptoms are mostly relieved, you can have a course of antibiotics to treat the intestinal bulges.
- Surgery - If you are experiencing a severe case of acute diverticulitis, you may be offered surgery. During a colectomy you will have the affected section of intestine removed, and the remaining colon will be temporary, or permanently, diverted into an external bag.
- Ulcerative colitis - Uncomplicated ulcerative colitis can be managed at home. If you experience a severe flare-up, you may be admitted to hospital so the condition of your colon can be monitored. There is a risk of a hole developing in the bowel if treatment is not sought early enough.
- Medications - Your GP will prescribe medications to prevent flare-ups and treat your symptoms when they occur.
- Hospital treatment - To monitor the colon and treat any damage.
- Surgery - In the worst scenario, your colon may be removed, and your small intestine will be diverted into an internal or external pouch. This is often an emergency solution to treat colitis that is unresponsive to other treatments, or frequently relapses.
IMPORTANT: Any pelvic surgery can result in damage which leads to further pelvic pain and disorders. It is important that you research into all other treatments before settling for surgery, which often has other irreversible impacts on your pelvic health.
To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.
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