For nearly three years, student nurse Anna Flood went back and forth to her GP about her fatigue and indigestion.
The GP was sympathetic, but reassured her that the problem was not a disease or an infection, but stress.
Anna, now 28, says. ‘I was permanently exhausted and pale. But I was doing an MA and working in a museum and for a while I was also convinced my ill health was due to my busy life.’
However, her symptoms just got worse. ‘I’d come home from work and fall asleep — then wake up in the night with sudden agonising abdominal pain.’
After struggling with fatigue and indigestion for nearly three years, Anna Flood discovered she had a tumor
Anna, who lives in Bristol, went back to her GP repeatedly, but each time it was the same story.
‘I was diagnosed with indigestion or irritable bowel — but always the underlying problem was my “stress”.
‘I bought over-the-counter iron tablets and tried to carry on,’ she says. Then one morning in 2011, three years after her symptoms began, she fainted on the train on the way to work.
‘My mother decided enough was enough and drove me to AE,’ she says.
There, a CT scan revealed a tumour in her large intestine and she had emergency surgery to remove a section of her large intestine and the end of her small intestine.
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Anna concedes that bowel cancer among young people is rare but says that the fact that her real diagnosis was overlooked for so long has inflicted long-term damage.
‘It’s taken a massive physical toll,’ she says — not least as her gut can no longer absorb vital nutrients.
‘I found out later that if I’d had a blood test to check for anaemia when I first felt ill, the results would almost certainly have raised concerns that this was more than stress.
‘I’d have got the right investigations that would have led to prompt diagnosis and treatment.’
And yet her doctor’s initial diagnosis of stress is entirely understandable, for as the latest figures suggest, stress is becoming an unstoppable epidemic, and particularly among women.
Recent statistics suggest that stress is turning into an unstoppable epidemic, and particularly among women
Last year, nearly half a million people took 9.9 million days off sick because they were stressed, according to the Health and Safety Executive, up by 25 per cent since 2014.
Furthermore, almost three million of us, around four in 100 of the population, suffer persistent disabling levels of anxiety and stress, according to research, just published in the journal Brain and Behaviour.
The term ‘stress’, originally borrowed from engineering (it refers to the level of pressure that causes a structure to buckle), is now a byword for the pressures of modern life.
And tellingly, the Cambridge researchers found that women are twice as likely to be affected as men.
‘When faced with stressful situations, women tend to ruminate about them which can increase their anxiety,’ explains Olivia Remes, who led the research.
MEN LESS PRONE TO WORK STRESS
Women who have long working hours may be particularly at risk.
Research published last week in the Journal of Occupational and Environmental Medicine found that women — but not men — who work an average of 60 hours a week over three decades are three times more likely to have a heart attack or stroke or develop type 2 diabetes or cancer compared with those who work a normal nine to five.
Allard Dembe, the lead researcher and a Professor of Public Health at Ohio State University, argues that the different findings for women underline an important concern about working hours and stress: the extent to which people enjoy work and are able to make choices about what they do.
Women, he says, are more likely to be in jobs that are monotonous, with little control over how or when they work.
Recent studies show that men are less prone to serious health risks as a result of stress and long work hours
The ability to ‘run meetings, set deadlines and decide when you work is a leading factor in whether people suffer chronic illness and die early,’ adds Michael Marmot, a professor of epidemiology and public health at University College London.
Add to this women’s other responsibilities — as the Cambridge researchers pointed out, in the past, women tended to stay at home and be responsible for the family, but they are now more likely to hold down a job while bringing up children as well.
The risk is not from the kind of adrenaline-rush stress that comes to mind when most of us think of stress, explains Professor Stephen Bloom, Head of the division for diabetes, endocrinology and metabolism at Imperial College, London.
‘When we talk about stress, we tend to think that it’s the fight or flight response that makes people ill,’ he says. ‘But the killer is when your life is a constant problem, you are living with your mother-in-law who you hate, you’re doing a job you don’t enjoy.
‘You try to fight it but eventually you become resigned to it,’ he says.
‘You become anxious and depressed and your body gives up — your immune system is impaired, you develop a greater tendency to blood clots and your wound healing is impaired. It’s a kind of biological death wish.’
In the past, women tended to stay at home and be responsible for the family, but they are now more likely to hold down a job while bringing up children as well.
HEALTH DANGERS BEING IGNORED
Not only do women appear more likely to suffer stress, there seems to be too little awareness of the debilitating burden caused by the problem.
Experts, among them the UK’s Health and Safety Executive, say chronic stress is a major clinical issue that needs to be recognised, with links to a host of health problems ranging from headache, palpitations and an upset stomach, to psoriasis and irritable bowel syndrome to heart disease and type 2 diabetes.
And scientists from the Monash Institute of Pharmaceutical Sciences last week reported that emotional stress may even speed up the spread of cancer to other parts of the body — at least in ‘stressed’ mice.
Stress turns the body’s lymphatic system (the network of vessels that maintains the immune system) ‘into a super highway for cancer cells’, according to lead researcher, Dr Erica Sloan.
‘Stress sends a signal into the cancer that allows the tumour cells to escape and spread through the body six times faster in stressed mice compared to non-stressed mice’.
Experts say chronic stress is a clinical issue that needs to be recognised, with links to a host of health issues
Another animal study, in the journal Nature Reviews Neuroscience in 2012, found stress can ‘close down’ cells in the part of the brain that processes emotion and memory.
And the journal Psychosomatic Medicine reported last September that people who rate their working conditions as ‘extremely stressful’ are 45 per cent more likely to develop type 2 diabetes than those under minimal pressure.
The results were based on a 13-year study of 5,000 men and women.
A new line of research is investigating a possible link between stress and heart attacks.
As Andrew Steptoe, the British Heart Foundation’s Professor of Psychology at University College London, explains: ‘My team has discovered that in some patients, intense episodes of anger and stress occur in the hours immediately before the onset of chest pain.’
WOMEN WRONGLY TOLD IT’S STRESS
Women may be more stressed, but they are also more likely to end up with a wrong diagnosis of stress than men with the same symptoms.
This was starkly demonstrated in 2009 in an experiment at Columbia University where 230 doctors were presented with case studies of a man and a woman both suffering from chest pain and shortness of breath — typical symptoms of a heart attack — but who were also complaining of stress.
Twice as many doctors judged the women to be suffering ‘psychogenic’ (all in the mind) symptoms — ie stress — with most men diagnosed with heart symptoms and judged as suitable to be referred for treatment.
The risk here is that women don’t get the right medical treatment. Patients, too, assume too quickly that stress is the problem, as Anna’s story highlights.
In a study at Columbia University, twice as many women were judged to be suffering ‘psychogenic’ symptoms
That can lead to delays in going to the GP in the first place, points out Deborah Alsina, chief executive of Bowel Cancer UK.
Many of us do just this — a survey by the consumer organisation Mintel, published last week, found that three in ten women who suffered a stomach upset over the last year didn’t bother to see a doctor because they assumed stress was the main cause.
Kate Mackellar-Still, 27, was eventually diagnosed with multiple sclerosis in June 2015, which was a year after an emotionally painful separation from her boyfriend.
But even when she did seek help for her symptoms, ‘strange sensations in my legs and up to my waist’, for months they were considered by a neurologist to be ‘symptoms of stress due to my break-up’.
‘It made sense then,’ says Kate, a teacher from Bristol. Fortunately, the neurologist referred her for a brain scan ‘just in case’.
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IS IT JUST A SIGN YOU’RE BUSY?
The bigger question for both women and men, however, is whether ‘stress’ is a genuine medical problem or a normal human emotion that afflicts us all at some time.
It’s a question Britain’s GPs face every day of the week ‘with no easy answers’, says Dr Tim Ballard, a GP in Wiltshire and vice chair of the Royal College of General Practitioners.
Doctors are all too aware that even moderate levels of chronic stress are said to lead to ‘psychosomatic’ symptoms, most commonly headache, backache, palpitations or upset stomach, causing genuine suffering without medical explanation, he says.
‘A patient who presents with a headache is most likely to be suffering from stress or anxiety,’ says Dr Ballard. ‘There’s only a tiny chance they might have a brain tumour or dangerously high blood pressure.
‘A good GP will balance the need to avoid medicalising normal behaviour — while never ignoring the possibility of a more serious illness.’
Do we need prescription medication to treat stress-induced health problems, or would that be a step too far?
But some experts feel ‘stress’ is too readily used as a label for everyday emotions.
‘The term is misapplied to a whole range of normal human emotions: worry, anger, anxiety and frustration as well as common physical symptoms such as tiredness,’ says Angela Patmore, a former stress advisor to the Metropolitan Police and author of The Truth About Stress.
‘People say they have stress when they are just busy — they don’t have a medical condition.’
She believes labelling normal experience as stress makes people worry there is something abnormal and dangerous about how they feel.
Worse, she says, is the rise in the prescribing of antidepressants or sedative drugs to manage stress, bearing in mind concerns about the risk of potential side-effects including addiction.
There are also question marks over stress ‘causing’ serious medical problems — ‘research has not shown that stress is a direct cause of coronary heart disease,’ insists Lucy Wilkinson, senior cardiac nurse at the British Heart Foundation.
The charity, Cancer Research UK, takes much the same view. ‘A few studies have found a link between stress and cancer, particularly breast cancer,’ says Dr Jana Witt, the charity’s health information officer.
‘But most have only looked at a small number of participants or asked women to recall if they were stressed before they developed the disease, which isn’t a reliable way of measuring stress.’
LAVENDER OIL IS NOT THE SOLUTION
Angela Patmore worries that the relaxation and de-stressing industry encourages people to abandon problem-solving and rely on pampering
Indeed, the mainstream clinical consensus is it’s not stress itself that does the damage but the way we ‘manage’ stress.
‘These are different forms of avoidance behaviour or putting your head in the sand,’ explains Sir Carey Cooper, professor of organisational psychology at the University of Manchester.
‘Smoking, drinking and eating too much might provide temporary relief.
‘But in the long term using them as a crutch won’t solve your problems, they’ll create new ones.’
For both sexes, exercise helps, as does talking to friends, family or seeking help from a counsellor.
‘Relaxation is valuable but it won’t help you solve the problems that are causing the stress — whether it’s a blocked career at work or a bad relationship.’
Angela Patmore worries that the relaxation and de-stressing industry — aromatherapy bath oils, yoga holidays in Bali, mindfulness courses or massage — is at best unhelpful by encouraging people to abandon problem-solving and rely on pampering.
‘People who face difficult situations are being told that rather than working harder and addressing their problems, all they have to do is relax and all will be well.
A herbal bath may be relaxing, but when you get out, you face exactly the same problems except you’re more likely to blunder on in a haze of lavender-infused relaxation,’ she says.
To find out more about Bowel Cancer UK’s Never Too Young campaign go to bowelcanceruk.org.uk/campaigning