Dear Dr. Christina,
My 76-year old mom was a widow and had not gone to her doctor for a few years. When she did go, she was told she did not have to have a pelvic exam or a Pap® test any longer. She has always suffered from constipation. Whenever she had a bout of it, she would bleed. She would go to her doctor and was told not to worry about it. He told her the bleeding was most likely caused by her hard stools and her hemorrhoids. She was told to go to the store and buy some Preparation H®, some stool softeners, and eat plenty of fiber.
I live clear across the country and had not had time to visit with her until now, since that I am no longer working. During my visit, my mom told me that her hemorrhoids have really been acting up. When I asked her how long she has had this problem, I was taken aback when she told me for 10 years. She told me not to worry and that she had told her doctor about her constipation and bleeding. She said he told her not to worry about those hemorrhoids.
I became alarmed when I saw some bright red blood in my mom’s toilet, so I made her make an appointment with a local gynecologist quickly. She laughed and said she did not need to go to that type of doctor because she was not pregnant. I told her a gynecologist does more than just deliver babies and I thought she should have a thorough pelvic exam.
The gynecologist did a pelvic exam and looked to see where her bleeding was coming from. He told us that Mom looked okay and that she only had a small hemorrhoid. However, as he did his rectal digital exam, his finger came out bloody and he told us he felt a mass the size of a baseball in her rectum. Everything happened so fast after that. She was then seen by a surgeon who biopsied her lesion. That’s when we found out that she had rectal cancer. I was shocked to find out after doing a cat (CT) scan and positron emission tomography (PET) scan that the cancer had metastasized throughout her body. She died four months later.
The reason I am writing to you is that I felt so guilty for not asking my mom more questions when she told me about her rectal bleeding and the change in her hard stools. I should have been there for her.
I am so sorry for your loss. I want to express to you that you did not do anything wrong. Many times people assume that the cause of their rectal bleeding is hemorrhoids, including doctors. The fact that it took 10 years to find the mass and that it had 10 years to grow and develop undetected explains why it was found in the latter stages of colorectal cancer.
Colorectal cancer is the 3rd leading cause of death in the United States. It is projected that 96,830 new cases of colon cancer will be found in 2014 and 40,000 cases of rectal cancers. Many times men and women are told to have a screening colonoscopy at the age of 50; however if there is any family history or any changes in their stool size, consistency or blood, they need to have a rectal exam and possibly a colonoscopy. Many times benign polyps, inflammation of the bowel, anal fistulas, hemorroids or strictures may be found that can be the culprit for the bleeding, change in stool size or consistency. Chronic rectal or hemorrhoid bleeding needs investigation.
Oftentimes people want to deny anything is really wrong, so they will procrastinate going to their doctor or they will be hesitant to tell their doctor about the bleeding because they are embarrassed to have their doctor examine them down there.
On the other hand, sometimes doctors get so busy and may not really listen to what the patient is telling them, especially as to the length of time the bleeding has occurred and the changes in bowel habits.
I think it is so easy to assume when one thinks of constipation and rectal bleeding that it is only hemorrhoids. Your mom has now left a legacy, along with your letter, by you reaching out to tell her story. This alone will probably save many lives. I hope patients will now be advocating for more complete exams and ask their doctors to be more proactive and preventative in their examinations.
If there is any doubt in your mind or if you have an elderly person who is having problems, perhaps have someone go with them, or you, to their doctor’s appointment to ensure that proper care is given and to help them understand the doctor’s instructions. They should also make sure the doctor understands the patient’s concern and takes the time to listen to the patient’s questions. If the doctor doesn’t provide a complete examination, have the patient request that a particular exam be done.
You have to be your own best advocate in order to ensure your health and partnership with your physician.
Molly, my thoughts are with you. I appreciate you helping others to learn from your mom’s story!
- Posted By: DRC Editor
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