A patient reports seeing blood in the toilet and is worried her husband has a serious problem. Discover how to handle this tricky situation with our scenario for dispensary staff
Maddie Jacobs pops into the pharmacy shortly before closing time and heads over to the end of the counter, indicating that she'd like a quiet word.You lead her into the consultation room and she explains the situation.
"I'm a bit worried about my husband," she begins. "I know he won't come in himself – you know what men are like – so I thought I'd ask for him and then try and talk to him about it.
"He seems to be having problems when he goes to the toilet. He thinks he can't be heard, but I sometimes hear him moaning and he looks a bit uncomfortable when he comes out.
"Last night I went in the bathroom after him and noticed a few spots of blood on the seat. I'm really worried something is seriously wrong."
Can you tell me?
1 What is the problem likely to be?
2 What other conditions could it be?
3 What could you suggest to help ease symptoms?
What OTC says
1 The most likely explanation, given the symptoms and blood, is an anal fissure.This is a tiny tear in the lining of the patient's anal canal and is most often caused by constipation. Other causes of anal fissures are much less common and include pregnancy, childbirth, chronic diarrhoea, inflammatory bowel disease and some sexually transmitted infections.
Anal fissures affect men as often as women and occur in people of all ages, including children.
The symptoms are pain when going to the toilet (often described as "passing broken glass") followed by a deeper pain that can last for several hours, and bleeding, which is bright red and is usually seen on the toilet paper, on the seat, or on the surface of the stools. You should suggest Maddie urge her husband to see his GP as soon as possible.
2 Other conditions that could cause these symptoms include haemorrhoids (though there is often itchiness around the anus and the patient is usually aware of the swollen blood vessels in their rectum or anus) and cancer.In particular, bowel cancer is a concern; it is important this is diagnosed quickly as it can be treated in early stages, but if advanced only 6 per cent of patients survive more than five years. Again, it's important for Maddie to urge her husband to see his GP urgently to rule this out.
3 Anal fissures may be acute, when the symptoms last no longer than six weeks, or chronic.Acute fissures often heal on their own without any medical treatment, but adopting a high fibre diet can both ease the symptoms and speed up the recovery as the fibre bulks out the stools, making them easier to pass.
Drinking plenty of water will also help, as it will prevent the stools drying out and becoming difficult to pass.
Laxatives may also be used for the same purpose. Chronic fissures are less common than acute anal fissures, and treatment varies according to the individual.
Medication that may be used includes painkillers, topical anaesthetics or glyceryl trinitrate ointment.
Less commonly, topical calcium channel blocker preparations or botulinum toxin injections may be employed, and surgery may be used as a final resort.