Blood in the Bowl

Read This First

You looked down and there was blood. On the paper, on the poo, or turning the water pink. Maybe it was this morning. Maybe it's been happening on and off for a year and you've stopped mentioning it, even to yourself. Maybe your stomach has been "funny" for months, or a doctor glanced at you and said "it's probably piles", and you were so relieved you didn't ask how they knew.

This book is for you. It's also for the person who has had the bowel screening kit sitting in a drawer since spring, and for anyone living with a gut that runs their life.

Most bleeding from the bottom is not cancer. The point of this book is to make sure yours isn't the exception.

That sentence is true. Bleeding from the bottom is common, and a small one-off bleed is usually not serious. Even among people a GP refers urgently for suspected cancer, most turn out not to have it. But bleeding is also one of the ways bowel cancer shows itself, and bowel cancer found early is far more curable than bowel cancer found late. You can't tell which one you have by looking. Nobody can. That is what tests are for.

What this book is

• Plain words. Poo, bum, anus, rectum, blood, leaking, piles. If you can't say it, you can't describe it to a doctor, and the description is half the diagnosis.
• What normal looks like, so you can spot a real change.
• How to read blood: which kinds mean "book an appointment this week" and which mean "go to the emergency department now".
• The honest version of piles, fissures, bowel cancer in younger adults, screening tests and the colonoscopy prep, IBS, Crohn's and colitis, problems of the anus itself, leaking, and the cleanses and creams people use to avoid a doctor.
• Word-for-word scripts for the appointment, including what to say if you've been brushed off.
• A Gut Check Record at the back: a two-week diary, a red-flag self-check, your screening plan and your doctor script.

What this book is not

• It is not a diagnosis. It can't examine you, test your poo or look inside your bowel, and neither can a photo, a forum or a description. Use it to get to the right test faster.
• It is not medical advice. It prepares you for a conversation with a clinician who can examine you.
• It does not tell you how to treat yourself. No home removal of lumps or piles, no cleanse recipes, no "safe" detox. Chapter 11 explains why.
• MediQuestAI does not diagnose, prescribe or treat. The link at the back helps you keep your diary and history in one place for your appointment. That's all it does.

Danger now?

Stop reading and get emergency help (911 in the US, 999 in the UK, 999 or 112 in Kenya, or your local emergency number) if:

• you are passing a lot of blood or large clots, the toilet water turns red, or the bleeding won't stop
• your poo is black, sticky and tar-like (iron tablets can darken poo, but if you're not sure which you're looking at, treat it as blood)
• you feel faint, dizzy, breathless or your heart is racing while you're bleeding
• you have severe belly pain with vomiting, and can't pass poo or wind

Don't drive yourself. Bring your medicines with you.

The full list is on the Go Now Card at the back of this book. Screenshot it now.

How to use this book

You don't have to read it in order. Pick the line that fits you today.

• I've seen blood. Read chapter 3 (Reading the Blood) now. Then chapter 4 if you think it's piles, and chapter 5 whatever your age. Then chapter 12 and book the appointment.
• I've been offered screening, or I'm 45 or older. Read chapter 6 (Screening), then chapter 5 for family history. Put a date in your diary before you put the book down.
• My gut has been wrong for months. Start with chapter 2 (What Normal Looks Like), then chapter 7 (IBS or Something Worse?). If you already have Crohn's or colitis, chapter 8 is yours.

Chapters 1 to 3 are the foundation; every later chapter leans on chapter 3's way of reading blood. Chapters 4 to 11 stand on their own. Chapter 12 pulls it together into what to say and do.

Where else to look

Some topics touch this book but live in other books in the MediQuestAI Health Library:

• prostate and testicle checks: The Exam Men Dodge
• sexually transmitted infections, HPV vaccination and cervical screening: The Clinic You Avoid
• tears, leaking and prolapse after giving birth: The Six-Week Lie
• laxatives and "detox" products used to lose weight: Thin at Any Cost
• emergencies in general, such as sepsis and blood clots: It Was Just a…

Stories in this book

Where a chapter opens with a real person or event (a public figure who spoke about their own illness, a published medical case report), we say so and cite the source. We only repeat what they or their families made public.

Some stories are composites; names and details are changed. A composite in this book never contains a real patient's words, a real clinic's name or a statistic. The numbers live in the main text, with a source for each one.

About this book

This book is educational. It is not medical advice, and it is not a substitute for a clinician who knows your history. If you have warning signs now, use the Go Now card or call your local emergency number. For everything else, take the questions in this book to a doctor, nurse or pharmacist.

*Facts in this book were checked against sources available in October

1. Screening ages, test types and referral rules change. Check the current rules where you live before you rely on any of them.*

Nobody Talks About Bums

In 2016, a deputy head teacher and mother of two in England was diagnosed with bowel cancer. She was 35. The BBC later reported that it was stage 4 when she found out, meaning it had already spread .

Her name was Deborah James. Instead of keeping it quiet, she did the one thing almost nobody does: she talked about her poo. In public. On a blog, in a newspaper column, and on a BBC podcast called You, Me and the Big C. She recorded episodes wearing a poo costume she'd ordered online in an anaesthetic daze after an operation. When she signed off her last episode in May 2022, weeks before she died at 40, her final words to listeners were these: "Check your poo. Come on. I can't leave on any other word apart from check your poo" .

The fund she set up in her last weeks raised millions of pounds for cancer research. But the thing she kept coming back to was cheaper than any research. Look in the bowl. Say what you see.

Four years after Deborah's diagnosis, in August 2020, the actor Chadwick Boseman died of colon cancer at 43. He had been diagnosed four years earlier and had never spoken about it publicly; most of the world found out from his family's statement. He kept making films the whole time.