Without even realising it, your world sometimes gradually gets smaller: less walking, fewer days in the office, cancelling on friends. Watching plans disintegrate on the chat as friends struggle to settle on a date or place for a catch-up.

You might start to feel a bit flat or disconnected. Subtle changes in habit and mood take hold. Could you be … lonely?

It’s not a label many of us identify with easily, especially if you know you’ve got friends, or are in a happy relationship.

But loneliness can happen to us all from time to time – and identifying it is the first step to fixing it.

So, what is loneliness?

Loneliness is the distress we feel when our relationships don’t meet our needs – in quality or quantity.

It’s not the same as being objectively alone (otherwise known as “social isolation”).

You can feel deeply lonely even while surrounded by friends, or totally content on your own.

Loneliness is subjective; many people don’t realise they’re lonely until the feeling becomes persistent.

What are some of the signs to look for?

You may feel a physical coldness, emptiness or hollowness (I’ve heard it described as feeling like you are missing an organ). Some research shows social pain is experienced similarly in the brain to physical pain.

Behavioural signs may include:

• changes in routine
• trouble getting to sleep or staying asleep
• changed appetite (maybe you’re eating more or less than you normally would, or have less variety in your diet)
• withdrawing from plans you would usually enjoy (perhaps you’re skipping a regular exercise class, or going to shows or sports events less often).

Emotionally, you may feel:

• a persistent sadness
• tired
• disconnected
• like you don’t belong, even when you are with others.

You may also feel more sensitive to rejection or criticism.

But you’re not alone and you’re not broken.

Loneliness is a normal response to disconnection.

The late US neuroscientist John Cacioppo described loneliness as an evolutionary alarm system.

In the past, being separated from your tribe meant danger and risk from predators, so our brains developed a way to push us back towards connection.

The pain of loneliness is designed to keep us connected and safe.

Why is it often hard to recognise loneliness?

Sadly, there’s still a lot of stigma around admitting loneliness, especially for men.

Many people resist identifying as lonely, or feel this marks them as a “loser”.

But this silence can make the problem worse.

When no one talks about it, it becomes harder to break the cycle of loneliness, and the stigma remains.

While passing loneliness is normal, chronic or persistent loneliness can hurt our health.

Research shows chronic loneliness is associated with:

• depression
• anxiety
• weakened immunity
• heart disease
• earlier death.

Loneliness can also become self-reinforcing. When loneliness feels normal, it can start to shape how you see the world: you expect rejection, withdraw more and the cycle deepens.

The earlier you notice you’re lonely, the easier it is to break.

But I’m in a relationship, have loads of friends and a rewarding job

Yes, but you can still be lonely.

Most of us need different kinds of relationships to thrive. It’s not about how many people you know, but whether you feel connected and have a meaningful role in these relationships.

You may feel lonely even with strong friendships if you are lacking deeper connection, shared identity or a sense of community.

This doesn’t mean you’re ungrateful, or a bad friend.

It just means you need more or different kinds of connection.

OK, I’ve realised I am lonely. Now what?

Start by asking yourself: what kind of connection am I missing?

Is it one-to-one friendships? A partner? Casual social interactions? A shared purpose or community?

Then reflect on what’s helped you feel more connected in the past. For some, it’s joining a choir, a book club or a sports group. For others, it may be volunteering or just saying “yes” to small social moments, like chatting with your local barista or learning the name of the local butcher.

If you’re still struggling, a psychologist can help with tailored strategies for building connection.

The structural causes of loneliness

It’s also important to remember loneliness is often not because of personal failings or overall mental health.

My own research shows loneliness is often shaped by structural factors, such as poor planning in our local neighbourhood environments, financial inequality, work pressures, social norms, or even long-term effects of restrictions from the COVID pandemic.

We are also learning more about how climate change can disrupt social connection and worsen loneliness due to, for example, higher temperatures or bushfires.

Loneliness is normal, common, human and completely solvable.

Start by noticing it in yourself and reach out if you can.

Let’s start talking about it more, so others can feel less alone too.

Marlee Bower, Senior Research Fellow, Matilda Centre for Research in Mental Health and Substance Use, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Anal cancer doesn’t get a lot of attention. This may be because it’s relatively rare – anal cancer affects an estimated one to two Australians in every 100,000. As a comparison, melanomas affect around 70 in every 100,000 people.

But it’s also likely due to embarrassment. Anal cancer is an abnormal growth in the cells lining the anus, the last few centimetres of the bowel. Many people feel awkward talking about this part of their body.

So, when symptoms appear – such as bleeding or itchiness – they may delay speaking to a doctor. But it’s crucial to know what to look for, because if anal cancer is caught early the chances of treating it are much higher.

Do we know what causes it?

Up to nine in ten anal cancers are caused by human papillomavirus (HPV), a sexually transmitted infection.

HPV is common – more than 80% of people who have ever been sexually active will be infected at some point with a strain (there are more than 150).

Most HPV strains won’t cause any problems. But some, particularly HPV16, are higher risk. Persistent infection can cause changes in the anal lining and this can progress to anal cancer. This can happen even if you don’t have anal sex.

Vaccination against HPV is a highly effective method to reduce the risk of cancers related to HPV infection such as anal and cervical cancer.

Since the national HPV vaccination program began in Australia in 2007, there has been a substantial drop in diseases linked to HPV (such as genital warts). While it’s too early to say, it is hoped that over time cancer rates will also fall due to vaccination.

Other factors that increase your risk for anal cancer include:

• being older
• a history of smoking
• a weakened immune system (for example from medication or HIV)
• sexual activity (having anal sex or multiple sexual partners)
• a history of cervical, vulval or vaginal cancer.

What are the symptoms?

Sometimes anal cancer doesn’t cause any symptoms. A doctor may instead detect the cancer visually during a colonoscopy or another examination.

Other times, symptoms may include bleeding from the bottom (you might see blood on the toilet paper), a new anal lump, or feeling non-specific discomfort or itchiness in your anus.

You may also have an unusual sensation that you can’t pass a stool as “fully” or easily as before.

If you have any of these symptoms – particularly if they are new or getting worse – it is important to speak with your doctor.

The symptoms of anal cancer can be very similar to common conditions such as haemorrhoids, so it’s best to get them checked by a doctor to get the diagnosis right.

It’s understandable you might be embarrassed. But for doctors, this is all part of routine practice.

Catching it early improves your chances

Survival rates are much better for anal cancer caught in the early stages.

Around 90% of people diagnosed with stage one anal cancer will live five years or more. That drops to 60% if the diagnosis is made when the cancer has developed to stage three.

The test may be as simple as a quick anal examination. Or it may require other investigations such as anoscopy (looking inside the bottom with a slim tube) or specialised ultrasounds or scans.

Most tests involve only a small amount of discomfort or none at all. They can rule out anything serious, giving you peace of mind.

If a cancer is detected, treatment usually involves radiotherapy, chemotherapy or surgery, or a combination.

The bottom line

If you need another reason to get symptoms checked out, here’s one: they could also indicate bowel cancer.

Bowel cancer (also known as colon or colorectal cancer) is the fourth most common cancer diagnosed in Australia, and the second most common cause of cancer death, with similar symptoms such as bleeding from the bottom.

So, it’s crucial to not to let awkwardness get in the way. Speak to your doctor if any symptoms concern you. Starting the conversation early could save your life.

Suzanne Mahady, Gastroenterologist & Clinical Epidemiologist, Senior Lecturer, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.