Invisible bowel conditions often difficult to talk about as well

“Living with IBS means carrying an invisible burden,” says Surmont. “There’s often nothing to be seen on scans or in blood tests, but the pain and shame are very real. It’s a silent struggle that society needs to understand better.”

Irritable bowel syndrome (IBS) is one of the most common Disorders of Gut–Brain Interaction (DGBI), formerly known as ‘functional’ gastrointestinal disorders. Globally, over fourty per cent of the population lives with at least one DGBI, and around five per cent suffer from IBS. The condition stems from a disrupted communication between the brain and the gut — known as the gut-brain axis. Signals constantly travel between the two via nerves, immune cells and the gut microbiome. Factors like diet, stress, or previous infections can upset that balance.

“A knot in your stomach or butterflies in your belly aren’t just figures of speech,” Surmont explains. “There really is a connection between the brain and the gut — the gut-brain axis. It’s biology: our emotions directly affect how our gut functions.”

Patients experience abdominal pain, often accompanied by symptoms like bloating and fatigue. Standard medical tests usually come back normal, because the issue isn’t structural, but functional — a problem in how the gut works, not how it looks. And function doesn’t show up on a scan or in blood results. This often leads to frustration for patients, and misunderstanding from those around them. Because “nothing’s wrong”, at least on paper. “A normal colonoscopy doesn’t mean the patient is healthy. Their symptoms are real — we just can’t capture them in a scan or blood test.”

Treatment is tailored to the individual and targets several levels: dietary adjustments (such as a low-FODMAP diet), gut-specific medication, and therapies that address pain perception. IBS is a chronic condition, but in most cases, it can be well managed.

Conditions affecting the anus, such as haemorrhoidal disease (issues with haemorrhoids) or fissures (tears in the skin), affect a large proportion of the population. Around one in four people will experience haemorrhoidal problems at some point, and one in ten will develop a fissure. Yet many avoid seeking help out of embarrassment. “There’s still a real sense of shame around talking about the anus,” says Surmont. “But the reality is these symptoms can seriously impact daily life. Medicine doesn’t stop where the bowels begin.”

A proctological examination is straightforward and can quickly lead to effective solutions. Seeking help early often prevents prolonged pain and unnecessary anxiety.

Anal cancer remains rare, with around 300 new cases diagnosed each year in Belgium, but the number is steadily rising. The disease is often detected late, as patients may feel too embarrassed to seek help or assume it’s just a harmless haemorrhoid. In many cases, a cancer diagnosis only comes after symptoms — such as bleeding, pain, a lump, or a feeling that “something’s not right down there” — have persisted for a long time.

The main cause is the human papillomavirus (HPV), a virus linked to several types of cancer, including cervical cancer. HPV infections are very common: around eighty per cent of people become infected at some point after becoming sexually active. In most cases, the immune system clears the virus on its own, but in a minority of people the infection persists for years and can eventually cause cancer. “HPV is invisible, but it can be life-changing,” warns Surmont. “The taboo around anal cancer means people wait too long to seek help — and that can cost lives.”

Certain groups are at higher risk of developing anal cancer, particularly people with weakened immune systems. This includes HIV-positive individuals, transplant recipients, and women with HPV-related lesions of the cervix, vagina or vulva. HIV-positive men who have sex with men (MSM) face an even higher risk — up to one hundred times greater than the general population. However, in both Europe and North America, the majority of anal cancer cases are still diagnosed in women without HIV, usually around the age of sixty. In these cases, HPV can spread from the vagina to the anus even without anal sex, meaning that this is not always a necessary risk factor. While the absolute risk remains low (roughly 2.3 cases per 100,000 person-years), vigilance is key.

The disease is often underestimated or mistaken for haemorrhoids or a small tear, which can delay diagnosis. But if anal cancer is detected at an early stage, the five-year survival rate is around eighty-five per cent. The standard treatment involves a combination of radiotherapy and chemotherapy.

Because HPV can go undetected for years and gradually cause changes in cells that may lead to cancer, this offers a vital window for prevention. In high-risk groups, early abnormalities can be picked up through an anal smear test — similar to the cervical smear used in women. If necessary, this is followed by a high-resolution anoscopy to closely examine any suspicious lesions. This makes it possible to treat precancerous stages before they develop into cancer. “We have a real window of opportunity to prevent this cancer,” Surmont concludes. “And that starts with being willing to talk — and to listen — even when the subject feels uncomfortable.”

Prevention is possible: the HPV vaccine, now routinely offered to both girls and boys in their first year of secondary school, protects against the most high-risk strains For high-risk groups, an anal smear is recommended to detect precancerous changes in time.

All of the conditions discussed above are covered in Surmont’s upcoming book Met de billen bloot (All laid bare), to be published in spring 2026 by Pelckmans. Blending scientific insight with patient stories, the book aims to break the taboo surrounding bowel and anal disorders.