How to sensitively push the matter?

[DearDinah]

My mum has refused a colonoscopy twice now.
She has had blood in her stool & has been told it's possibly polyps but they need to investigate.
She's scared I know she is, she has said before if she has something, she'd rather not know.
We lost DH's mum in February to colon cancer. She said she'd ignored all the symptoms & by the time her pain had got too much to handle the cancer had spread & there was no option for surgery. Two years of chemotherapy, but it was too far gone.
I'm terrified of cancer. Terrified it will take my mother too.
I'm 7 months pregnant, I know she's trying to spare me any upset, but her burying her head upsets me more. It could be absolutely nothing & we could all breathe a sigh of relief.
I don't know what to do, her health is her choice I know. The fear must be horrendous, but I love her so much. I want her well. Dad is not very tactful & ends up losing his rag & shouting, so can't really press him.

I had a colonoscopy for similar symptoms, last year. The preparation for it was pretty grim - the litre of stuff I had to drink was nauseating, and, IMO, worse than the effects it caused. The colonoscopy itself was not comfortable or pleasant, but was over pretty quickly - and I now know that I had polyps and some internal piles.

The important part is that the polyps were of a kind that aren't cancerous but can sometimes become cancerous. They have all been removed, so will not turn nasty, and I will need another colonoscopy in 10 years, in case any more of these polyps turn up.

Please tell your mum that, in my opinion, it is worth doing. My understanding is that it is more likely to be something other than cancer, and it would be far better for her to have her mind set at rest (and for you too) - and they may well be able to treat whatever is causing the bleeding, and test to see what sort of polyps she might have - and if they are the same as I had, removal will prevent any chance of them turning cancerous - which is a good thing.

Thank you for your reply. I'm sorry you had to go through that. I know she googles everything (as do I) and it's never a good thing. I will tell her it's a good likelihood the polyps can be removed safely & offer to go with her & look after her. I didn't realise the procedure was quite so grim, perhaps that's why she went to the appt & refused there & then. I just thought it was odd she would keep the appt if she already knew she wouldn't go through with it. Trouble is are they likely to offer it to her again, a third time.

I don't think there's a sensitive way to push the matter. If she really doesn't want to know then he's unlikely to listen to what you're saying. The only thin to do is give her all the facts you can.

Its an awful situation, I've been there with my mum. She had symptoms of cervical cancer for years but ignored/put down to menopause, we tried to get her to see the GP for years. By the time it was too bad to ignore any more the cancer had spread and was stage 4. I was 6 months pregnant with my youngest when we found out and 18 months later she was gone.

Is she scared of the results or the procedure? If the latter then there's different things that would help such as having it done under general anaesthetic.

The problem is, if she does have the tests and it is cancer, would she accept the treatment?

Thank you for replying crazykat I'm so sorry about your mum.
She's frightened of both I think & of causing her family upset. She's definitely fibbing about things, I can read her like a book.

In my experience (having had cancer - breast not bowel) the fear is almost scarier than the diagnosis. It is very scary to have the tests but ultimately the outcome is either - it's nothing serious, and everyone is very relieved, or it is something serious - treatment can start straight away, you know what is what, you talk to an oncologist, you have a plan to deal with it.

Ignoring it will not make it go away- it will only make it worse, and how ever terrifying it is to contemplate (and I know it is, I really feel for your mum) not knowing and worrying yourself ill, is worse.

I've had colonoscopy without sedation - its not fun, but its bearable, and over fairly quickly, I've also had one with sedation and I don't remember anything about it, - so if your mum is frightened of the procedure, there are options to make it less horrid. If she also feels embarrassed (and I know people do with these kind of things) IME the hospital staff are all extremely kind and respectful and help you through it, she will have a nurse sitting beside her throughout to talk to her and keep her calm.

Oh dear how difficult . Could you say sort of what you've said in your first post - that you love her very much and that her head in the sand approach ,while understandable and her prerogative,is causing you a lot of stress . That maybe she could take things one step at a time,have the teast and then decide ?

As far as the test is concerned the prep does involve taking a laxative and for some people this can be quite strong ,others don't react so much .

And of course with google you will come up with stuff about cancer ,but please remember that any statistical results will be based on trials some years ago and that treatment really has improved tremendously. Even the nasuea with chemo is very well controlled .

Take care .

By the way ,I've had cancer and had to have my oesphageous and some of my stomach removed .

The treatment honestly wasn't that bad and the NHS were fantastic .

Thank you all. I have text her as I think it's easier not face to face. She hasn't replied yet but it gives me something to follow up when I see her on Weds. At least she knows I'm not just going to let it go this time. I just asked her reasons for refusing & told her about general & that I'd look after her. She said when I called her earlier she'd wait until she was 60 (next Feb) & wait for the stool test they post you! She was trying to dumb it down to get me to drop it.

MIL refused a colonoscopy because she was scared and refusing to believe anything too bad could happen to her. She had a bowel tumour and endured months of increasing pain and eventually several days of utter agony as it obstructed her bowel. Getting seen earlier would have saved her all that.

Tell your mum you're 7 months pg and you need her to get sorted now cos you won't be available to help in 2 months time . Tell her you're worrying about her and it can't be good for the baby. Make this into something she can do for you. Might that work on her?

Sorry to hear this OP. please tell her that the stool test is a screening test, not a diagnostic test. She could easily have something benign and live another 30 years. Or she could have an early tumour and it be cured. She needs a referral as a 2week wait (if you are in England). Lots of gentle persuasion but also that you will be very hurt and upset if she doesn't do something about these symptoms and therefor increase her chance of cure.

In hospital I was next to someone who had a bowel obstruction and I wouldn't wish what she went through on anyone .

Your mum may have something else altogether causing problems but honestly just leaving and trying to ignore what might be a bowel obstruction is not a humane way forward .

I've had a colonoscopy - the extra-strength laxatives you have to take before hand are not fun, but the procedure itself is painless (you are usually given sedatives so you're pretty out of it anyway). I'm sure surgery/chemotherapy/the pain from advanced bowel cancer would be a million times worse.

OP I do hope you can talk your mum round.
I work in an endoscopy department and see people like this on a daily basis.
If her worry is the test itself, she can have sedation (if not contraindicated) or most places offer gas and air. We have special shorts for our patients so that they're bottoms aren't on show and afford them some dignity. She will have a nurse there to hold her hand, chat to, swear at or or completely ignore, whatever she needs.
The majority of polyps can be removed there and then and are the benign type, but we send them all off to the lab for testing. Larger ones would mean coming back and having another colonoscopy to remove them, by injecting a small cushion of fluid underneath and then removing. The reason it needs to be done another day is down to the lists, we only have 40 minutes per procedure and large polyp removal usually takes about an hour.
If there is something there that seems suspicious she will be told on the day, the chances are very small, especially without a family history of bowel cancer, the majority of blood from the bottom is cause by piles or polyps.
It's worth telling her now, that if she waits for her bowel cancer screening pack at 60 it's highly likely she will be invited to attend for colonoscopy as the tests just pick up blood in the stool and she is already experiencing this.
Feel free to PM if you have any questions.

west- that is interesting.
Both me and DH are fast approaching 60. I didn't know that the 60+ test just looked for blood- I thought it looked for other markers?
I have slight internal piles from pregnancies and very very occasionally there is a tiny bit of bleeding but it's fresh and not from anything else- I know that.
However, does this mean that it's almost certain I'd be invited for a colonoscopy if I took the test because I don't think I need it and am very health conscious- and for various other reasons have a low risk of bowel cancer- on HRT which reduces the risk, can't drink for other health reasons,almost a vegetarian and do lots of exercise.

The bowel cancer screen (or poo smear as we call it) test if done over three days (or three poos.) piles for example might only bleed irregularly, so the chances of all three samples being positive are low, but a growth or lesion would likely bleed more regularly and so the chances are that more of the samples would be positive which would indicate the need for colonoscopy.

Thanks for the information west she never replied to my text, skirted around it by sending me something else. I see her tomorrow so will push it then, if not I'll have to go through dad & try & find out exactly what's been said. She says there's no blood anymore, but to have asked her twice to come for a test must indicate something? Are they likely to ask her again if she's refused so far?

It's standard practice where I work to offer twice, then if people decline we will remove them from the waiting list. I don't know if that's a UK wide thing or not though. If you mum was being referred to us, she would have to go back to GP in order to be re-refered.
The tests not nice, and I can only talk about my department, but she will be looked after, we're not in the torture game. But if she won't come, she won't come, and she's got the right to make that decision as much as you don't want her to x