- Early signs of colon cancer include rectal bleeding and changes in bowel movements.
- Young patients can feel embarrassed to talk about early symptoms like constipation and diarrhea.
- Normalizing words like "poop" and "stool" can reduce stigma and lead to earlier diagnosis.
When Sarah Beran started noticing blood in her poop, she didn't know how to bring it up to her doctor.
"I felt like I went in there with my tail between my legs, and not only was I talking about poop, but I was talking about my butt and blood and it's just all these things you don't want to talk about," Beran, 39, told Business Insider.
Beran, who was later diagnosed with stage 3 colon cancer at age 34, went on to talk about bowel movements a lot: she co-founded Worldclass, an apparel brand that donates proceeds to fund colonoscopies for people who are underinsured.
Beran's experience of anal bleeding is not uncommon. It is statistically the most common warning sign of colon cancer in patients under 50. Studies show that many patients, like Beran, feel embarrassed to talk about it with anyone, including their doctors.
More young people are being diagnosed with colon cancer. Part of why it's so difficult to diagnose is that early symptoms like diarrhea and bloating can be caused by everything from hemorrhoids to a gluten allergy. The other hurdle is stigma: people just don't want to talk about seeing blood in the toilet or in their pencil-thin stools.
"Unfortunately, it's something that I see quite frequently," Dr. Fola May, a gastroenterologist and an associate professor of Medicine at UCLA, told BI.
She said it's common for people to ignore and they may avoid sharing their symptoms out of embarrassment. "They delay bringing it up until it gets more and more severe, and they actually can't function or have a normal workday," May added.
By then, their cancer is likely to have progressed to later stages.
Anal bleeding is common with younger patients
Early colon cancer symptoms are easy to miss. Abdominal pain or constipation can be linked to many different conditions, like celiac disease or IBS. That's why rectal bleeding is important to flag.
Joshua Demb, a researcher who studies early-onset colon cancer and an assistant professor at the University of California, San Diego, led a 2024 study on the most common symptoms of colon cancer in young people.
Demb's study found rectal bleeding was the most common sign of colon cancer — more than altered bowel movements or abdominal pain — because it was more specific and harder to explain with lifestyle changes.
It can be hard to know how seriously to take some symptoms. Anal bleeding is often caused by non-life threatening conditions like hemorrhoids. Some patients who are otherwise young, healthy, and who have no family history can be dismissed by doctors, partly because colonoscopies are more involved procedures and can cost a few thousand dollars without insurance.
The difficult work is making sure a symptom is "attributed to the correct condition," Demb said, without preemptively scaring people or overlooking the early signs of colorectal cancer.
Millennials are afraid to talk about stool
Poop has a long history of being taboo, regarded as unsanitary and embarrassing. As societies like Victorian-era England developed indoor plumbing and individual latrines to replace communal ones, defecation became more private — and consequently more shameful to talk about in public.
The stigma has never really gone away.
From interviewing colon cancer patients, Demb learned many young people are afraid to broach the topic of poop and rectal bleeding with their doctor, even though that conversation could be life-saving.
"Part of that apprehension comes from probably not having had to discuss this ever before in their care," he said.
As people enter their 50s and colonoscopies become standard care, talking about bowel movements becomes slightly more normalized.
When Naiké Vorbe started cycling through diarrhea and constipation, she didn't know how to talk about it, and hesitated at first. "You don't really speak about gastrointestinal issues," Vorbe, who grew up in Haiti, told BI.
Vorbe was diagnosed with stage 3B colon cancer at 31. By then, her cancer had spread so much that she needed to have parts of her colon and liver removed.
Chris Rodriguez, who was otherwise fit and healthy when he was diagnosed with stage 3 rectal cancer at 35, remembers feeling embarrassed about sharing his digestive agony with friends, relatives, and even doctors.
He feels from personal experience that younger people are averse to talking about cancer because they feel they're "not supposed to" be worrying about it yet.
"I know that people are too afraid to talk about these things with their doctor, too afraid to talk about these things with anybody around them," Rodriguez, now 37, told BI. "That's pretty scary for me."
Vorbe and Rodriguez both had late-stage cancer and rectal bleeding as a symptom. It makes the symptom all the more important to flag: sometimes, blood in the stool won't show up until the cancer has progressed.
The push to make rectal bleeding less taboo
Brooks Bell, one of the Worldclass co-founders, remembers struggling to share how she was feeling with her husband — they weren't the types to use the bathroom with the door open, for instance.
"Every relationship is different," Bell, 44, said. "Our relationship did not have those features, and so it can be so awkward."
Now, she and Beran are trying to help younger people feel emboldened to talk about colon cancer symptoms and taboo body parts. Their brand, Worldclass, sells merch that says "Ass" and "Colonoscopy Enthusiast."
Bell also founded Lead From Behind, a campaign backed by the Colorectal Cancer Alliance that involved Ryan Reynolds and Rob McElhenney getting colonoscopies on camera to normalize the procedure.
But ultimately, the biggest change might have to start in the doctor's office. Even though she's a GI doctor, May said she still gets patients who blush when they talk about their bowel movements.
May says she tries to shift that dynamic by being intentional about her language. "When I'm in public, I say words like 'rectum' and 'poop' and 'stool,'" she said, adding that she wants her peers to do the same.
Talking about blood in poop should be as normalized as talking about spotting breast cancer lumps, May said. "Until we make them normal in public," she continued, "people will feel uncomfortable producing those words from their mouths."
How to know if you have a colon cancer symptom, or if it's something else
Because early colon cancer symptoms can be so ambiguous, Demb said the more important thing to look out for is deviation from your lifestyle.
For example, if you normally have very consistent bowel movements and suddenly have persistent diarrhea, see a GI. If you have ongoing rectal bleeding for the first time in your life or unusual stomach pain that won't go away, consider booking a colonoscopy.
May also suggested getting a colonoscopy sooner if you have any family history of the cancer. She recommended getting screened at age 40 instead of the standard 45, and for primary care physicians to start bringing up the potential of screening before age 45 in general.
Because colonoscopies can be expensive and inaccessible to people under 45, the best anyone can do is be vigilant, Demb said of symptoms like anal bleeding.
Rodriguez, who is now cancer-free, believes it's important to investigate any warning signs. "You're not being silly by thinking about them," he said. "You're not overreacting by thinking it could be cancer."
Additional reporting by Kim Schewitz and Mia de Graaf.
