At the start of 2020, Iona “Fox” Woolmington experienced persistent diarrhea that she believed was food poisoning.
“I just thought, ‘I’m a healthy person. It’ll clear,’” the now 40-year-old from Chicago tells TODAY.com. “(I thought), ‘I probably have some kind of bug.’”
After three months, Woolmington knew that she needed to see a doctor. Then the COVID-19 lockdown started, which delayed her visit. When she was able to see a doctor, she learned she had Stage 3 rectal cancer and would need a temporary ileostomy as part of her treatment. That experience inspired her to write and illustrate a comic to explain what an ostomy — a surgical opening for waste to leave the body that bypasses its normal route — really is.
“It was definitely the thing I feared most,” she says. “It was also the thing that surprised me the most. What a relief it was and how unlike what I pictured it was. I was pretty uninformed about it, to be honest, and had a lot of assumptions.”
‘It’s just some weird thing I ate’
When the diarrhea started, Woolmington thought she might have food poisoning.
“I thought, ‘Oh it’s going to clear. I’m young and healthy. It’s just something weird I ate,” she recalls. “It sounds like maybe I have giardia.”
After three months of consistent diarrhea, she wanted to see a doctor. Then lockdown began and she had to wait another three months. When she finally scheduled a visit, the doctor dismissed her.
“They’re like, ‘You’re fine. It’s nothing,’” Woolmington says. “It did take a long time (for a diagnosis).”
Eventually, a doctor ordered a stool sample and after the results from that returned, they recommended a colonoscopy. About three days later, her doctor called.
“He said “Iona, you have cancer,’” Woolmington says.After that call, she switched to Northwestern Medicine for her care. She first underwent a fertility preservation procedure called ovarian transposition, where doctors moved her ovaries higher up in the body to protect them from radiation.
Then she underwent a week of radiation followed by chemotherapy for six months and then surgery to remove the tumor. During surgery, doctors also create an ileostomy, an opening in the abdomen that re-routes the ileum, the largest part of the small intestine, through it, allowing the stool to pass out of the body through a stoma, says the American Cancer Society. This gives the colon or rectum a chance to heal.
At first, Woolmington balked at the thought of an ileostomy.
“I saw it as incontinence,” she says. “I saw it as like, ‘Wow I’m not even going to be somebody who can control their pooping anymore.’ It was really scary to me at 35.’”
Even though Woolmington knew she was ill, she didn’t feel sick until she realized she needed the ileostomy. She hadn’t even lost her hair during chemotherapy.
“This ileostomy was the first material evidence that yeah girl, you are sick,” she says.
She held a lot of assumptions as to what this meant for her life.
“(I) was imagining based on fear,” she says. “I thought I’ll constantly be carrying around poop and it’ll smell, and I’ll be making fart sounds. None of those things are true.”
Instead, she found that having it was “a really good experience.”
“It was a huge relief after a year of a broken butt,” she says.
Colorectal cancer in young people
Colorectal cancer “is absolutely on the rise in young people,” says Dr. Mary Mulcahy.
“We don’t know why,” the hematologist and medical oncologist and one of Woolmington’s doctors at Northwestern Medicine tells TODAY.com. “Over the past 20 years, the number of patients … less than 50 with colorectal cancer is on the rise, and this is not only in the U.S. it’s throughout the world.”
But diagnosing colorectal cancer in young people still takes too much time because it's often not considered.
“People have a little bit of diarrhea. They have some abdominal pain. They get some constipation. They maybe detected an episode of blood in their stool,” Mulcahy says. “It gets dismissed (because) nobody’s thinking they could have colon cancer. And I hear this story multiple, multiple times throughout the day.”
A 2023 paper on young onset colorectal cancer patients found that 75% of patients visited two doctors before receiving a correct diagnosis and 20% saw four or more physicians. People who needed to visit more than three doctors received a late-stage diagnosis.
“Doctors think it’s gastroenteritis, irritable bowel. You can go all day listing diagnoses that could be causing these symptoms,” Mulcahy says. “People need to start putting colon cancer on that list.”
Symptoms of colorectal cancer include:
- Bloody stool
- Change in caliber of stool, such as narrower or stringy stool
- Abdominal cramps
- Diarrhea
- Constipation
- Unexpected weight loss
- Bloating
- Feeling urgency to have a bowel movement
- Bright red rectal bleeding
- Exhaustion
“The most important thing for young people is they need to listen to their body, and they need to not dismiss (their) symptoms,” Mulcahy says. “They need to find a doctor who is going to listen to them because sometimes doctors may dismiss it.”
She notes that while some patients, like Woolmington, need to undergo an ostomy, this depends on where the tumor is located. Many times the ostomy is temporary and assists the colon or rectum in healing. Often patients worry about needing an ostomy and believe misconceptions about what they are.
“When I’m speaking with patients, that’s one of the first things they want to know, ‘Am I going to need a bag,’” Mulcahy says. “It’s because of a lack of discussion, a lack of awareness … people don’t understand why they would need it. What it means. What it does.”
She applauds Woomlington for sharing her experience with an ileostomy in her comic.
“Iona did such a great job in making it real and making it something that will hopefully facilitate conversation,” Mulcahy says.
‘Verbal taboos’
During the summer of 2021, Woolmington underwent surgery to reverse her ileostomy, which was the end of her treatment.
“When the plumbing got hooked back up and that (was it),” she says. “I had one last scan, and they said, ‘You’re clear.’”
As a cartoonist, she felt motivated to capture her experience with the ileostomy as a comic called “Tough S___.” She addressed some misconceptions she and others have about colorectal cancer and ostomies.
“I didn’t know what an ileostomy was,” she says. “They’re practically verbal taboos. You don’t drop those words casually and I wanted to write about it because it has surprised me so much.”
The comic addresses how an ileostomy impacts body image and sex, for example, all topics that Woolmington faced while she had one.
“I had to learn those things,” she says. “I want to contribute to making them not so shameful if I can. I think that’s kind of the thing that keeps people from even getting checked out. It’s embarrassing to have poop problems.”
Woolmington marked four years without cancer, and she feels “pretty much back to normal.”
“I have a sense of my limits now. I also just treat myself better now, too,” she says. “I don’t think I’m invincible anymore. Health is wealth, as they say. I treasure it.”
