.jpg%3F2025-03-31T13%3A39%3A13.159Z&w=3840&q=100)
Colonoscopy, Constipation and the Conversations We’re Not Having
A Bowel Cancer Awareness Month Special with Miss Sarah Addison
Every April, Bowel Cancer Awareness Month highlights the importance of symptom awareness, early detection, and timely access to care. As the second leading cause of cancer-related death in the UK, bowel cancer is often treatable—especially when caught early.
This month, we spoke to Miss Sarah Addison, a Consultant Colorectal and General Surgeon with over two decades of experience. Sarah has developed a specialist interest in pelvic floor and functional bowel disorders, while also managing patients with colorectal cancer and benign conditions. She leads a multidisciplinary service in collaboration with uro-gynaecologists, offering expert care for complex bowel health issues.
Sarah shared her insights into everything from recognising red flag symptoms, screening and promoting gut health through reducing the stigma around normal bodily functions.
There are approximately 44,000 new cases of bowel cancer every year.
Bowel cancer—also known as colorectal cancer—affects the large bowel, which includes the colon and rectum. It’s the fourth most common cancer in the UK and the second biggest cancer killer, but it doesn’t have to be. Around 9 in 10 people will survive bowel cancer when it’s caught early, yet far too many cases go undiagnosed until it’s advanced. That’s why knowing the signs—like changes in your poo, bleeding, or ongoing tummy pain—and being aware of screening methods–such as FIT testing and colonoscopy–can genuinely save lives.
What are the signs & Symptoms of Bowel Cancer?
The way I see it, the bowel can only really do two things when something’s wrong: it can change how it works, or it can bleed. And while those two symptoms can be linked to thousands of different conditions, they’re always worth investigating.
If you notice a change in your bowel habits—whether that’s becoming more constipated or more loose than usual—or if you’re seeing blood in your poo, whether bright red or darker like it’s been there a while, it’s important to get it checked. Occasionally, people might feel a lump or mass in their tummy, though more often it’s picked up by a GP during an examination.
In most cases, your doctor will start with something called a FIT test—that stands for Faecal Immunochemical Test. It’s a quick, non-invasive way of checking for hidden blood in your poo, which can be a sign of bowel cancer.
And by ‘change in bowel habit’ we’re not talking about the odd loose stool after a dodgy takeaway. What we’re looking for is a persistent change—something that’s been going on for six weeks or more, like ongoing diarrhoea, constipation, or an alternating pattern. Another red flag is iron deficiency anaemia, which can sometimes be the result of slow blood loss from the bowel. That’s also a trigger for further investigation or a two-week wait referral.
What does a positive and negative FIT test entails.
The FIT test—which stands for Faecal Immunochemical Test—is a really simple test you do at home. It checks for hidden blood in your poo, which can be an early sign of bowel cancer. If it’s positive, it means blood has been detected, and you’ll usually be referred for a colonoscopy to find out more.
If it’s negative, that’s reassuring—it means no blood was found and bowel cancer is very unlikely. But no test is perfect. There’s a small chance (less than 1%) that it might miss something. So if your symptoms carry on or get worse, your GP might still refer you to us through what’s called the FIT-negative pathway.
That might mean a colonoscopy or a CT colonography. Both need bowel prep, which I know no one enjoys—but they’re really important tests. A colonoscopy lets us look directly at the bowel, remove any polyps (which can sometimes turn into cancer), and take biopsies if needed.
There are some rare genetic conditions, like Lynch syndrome, where cancer can develop without polyps, but most bowel cancers just happen without any family history at all. If we do find cancer, the next step is usually a CT scan and a discussion in a cancer team meeting to plan the best treatment—whether that’s surgery, chemotherapy, or both.
The main thing to know is this: if we catch bowel cancer early, the chances of a cure are really good. The FIT test is part of the NHS screening programme for people aged 54 to 74, and soon it’ll include people from age 50. It’s such a simple thing, but it really could save your life. We just need to get more comfortable talking about poo—because that’s where early detection starts.
It’s easy to overlook or delay a colonoscopy–they can be uncomfortable–but as Sarah shares, early action is so important.
My mother died of bowel cancer ten years ago.
She went from being perfectly fit and well—no symptoms at all, allegedly. She had just one rectal bleed. She went for a colonoscopy, and that’s when they found a sigmoid cancer. Unfortunately, it had already metastasised, and she passed away a year later.
She always insisted she didn’t have any symptoms. “I didn’t have any problems,” she’d say. But when we were clearing out her things, we found a huge stash of laxatives.
What she’d been doing was ignoring her constipation and treating it herself with over-the-counter laxatives. She dismissed the bleeding too, assuming it was just her haemorrhoids. I remember asking, “Have you had blood before?” and she said, “Well, yes—but it’s just my piles.”
I know FIT testing is helpful, and it has its place—but from a personal point of view, had my mother had a colonoscopy five years before her diagnosis, when her constipation started, she would still be alive today. So yes, I’m a strong advocate for colonoscopy.
I completely understand that I’m more of a colonoscopy advocate than the average person—because of my personal experience. But I truly believe my mother would have survived if she’d had that test earlier.
So we’ve talked about the clinical side—but there’s also this huge social barrier, isn’t there?
The thing is, we live in a society now where we talk about everything. People are really open about their sex lives, their sexuality, their personal beliefs—whether that’s religious, political, or otherwise. But the one thing we still don’t talk about?
Is pooping.
For many people, even saying the word “poo” feels awkward, let alone doing a test or seeing a doctor about it. Until we can get to a place where that becomes a normal, non-taboo topic, we’re going to keep running into problems. One of the worst things—especially for women—is the shame around needing to go whilst at work. If you walk into a toilet and need a bowel movement, there’s always someone going, “Ugh, that’s disgusting. Do that at home.”
I’m a huge advocate for pooping when you need to poop—because everyone has to do it. From a pelvic floor perspective, I see so many women who can’t go anymore because they’ve spent years holding it in at work.
And it’s all because it’s seen as embarrassing. But we’ve all got a bottom. We all pass gas—around two litres a day, in fact. And yet if someone farts in public, it’s totally vilified.
Honestly, I think we all need to be a bit more disgusting.
What advice do you have for someone experiencing the mentioned symptoms?
If someone has ongoing symptoms, it might not be bowel cancer—it could be something else entirely, and something we can help with.
The FIT test is fantastic, and it’s absolutely reassuring when it comes back negative. But if people are still worried, even after a negative result, I’d encourage them to speak to their GP and ask to see a specialist. Come to the hospital, see us—get checked out.
And please, don’t be embarrassed by bowel symptoms. These things are often very treatable especially when we catch them early.
For more information, or to book a consultation, contact us today.
Take control of your healthcare with Get Well Soon
Want to talk to find out more?
Call us free on 0800 994 9494