Haemorrhoids
Haemorrhoids (piles) are very common, and indeed 'haemorrhoidal cushions' are part of the normal anatomy of the anal canal. They can however cause very annoying and frustrating symptoms, from bleeding and itching (pruritus), to mucus discharge, prolapsing lumps and pain. It is important to ensure there is no other cause for the symptoms, and an endoscopic investigation may be recommended. Haemorrhoids are classified as internal (Grade I-IV), and external. A range of treatments are available, but often simple clinical advice to avoid straining and keeping the stool soft may be all that is required. Therapies I offer include banding, haemorrhoid artery ligation operation (HAL or HALO), stapled haemorrhoidectomy, and conventional haemorrhoidectomy. I am happy to discuss the advantages and disadvantages of each of these.
For more information:
gutscharity.org.uk/advice-and-information/conditions/perianal-disease
Anal Fissure
Fissures are tears in the lining of the anal skin, and present with severe pain when passing a stool, with blood sometimes on the paper. Treatment is initially with topical creams, and avoiding constipation, but surgery is sometimes necessary - this may involve an injection of Botox, or a lateral sphincterotomy.
For more information:
acpgbi.org.uk/_userfiles/pages/files/conditions/analfissure.pdf
Anal Fistula
Fistula are abnormal connections between the anal canal and perianal skin. They are common, and cause discharge, pain, abscesses, and sometimes bleeding. These can be challenging to treat, particularly when a "high" fistula-in-ano, as these involve the anal sphincters, and a number of procedures or techniques may be necessary.
For more information:
acpgbi.org.uk/_userfiles/pages/files/procedures/analabscessandfistula.pdf
Pilonidal Sinus
Pilonidal means "nest of hairs", and this is a condition where in-growing hairs cause sinuses, infections, and abscesses in the natal cleft (between the buttocks). An acute abscess may need to be drained surgically as an emergency procedure. Various operations are available to treat and eradicate the sinuses to prevent further abscesses. I perform a range of these, depending on the clinical situation, and am happy to discuss the surgical options. These include simple excision or laying open, Karydakis flap, Bascom's cleft closure, or a Limberg rhomboid flap. My principle is to do the minimal surgery needed to eradicate the problem.
Diverticular Disease
Diverticulum are out-pouchings of the bowel, is sometimes referred to as ‘wear and tear’ of the bowel, and is thought to be associated with our low fibre, high carbohydrate Western diet. Having diverticulae ("diverticulosis") is common, affecting 40% of 50 year olds, and 70% of those over 70. The majority of patients with diverticulosis do not develop any symptoms, and the only treatment required is simple dietary advice. However some patients develop symptoms of pain or alteration of bowel habit, others may have attacks of diverticulitis (infection arising from a diverticulum), or more serious complications such as abscesses, bleeding, or perforation.
For more information:
gutscharity.org.uk/advice-and-information/conditions/diverticular-disease
acpgbi.org.uk/_userfiles/pages/files/conditions/diverticulardisease.pdf
Irritable Bowel Syndrome (IBS)
There is a bewildering array of theories about IBS (not to be confused with IBD) and its causes; equally there is a plethora of advice and treatments available. This reflects the fact that no two patients are the same, and treatment can at times by a real challenge. The classical symptoms that are associated with IBS include alteration of bowel habit (constipation, diarrhoea, or even both), abdominal discomfort, and bloating. Any of these may be present. Initial management involves taking a detailed history, excluding any other cause for the symptoms, identifying possible triggers, and medical treatments.
IBS links
gutscharity.org.uk/advice-and-information/conditions/irritable-bowel-syndrome
Inflammatory Bowel Disease (IBD)
Crohn's disease and ulcerative colitis are common inflammatory conditions affecting the bowel, and often occur in young people. The cause of these diseases is unknown, and whilst in many patients the disease can be mild and self-limiting, some patients develop severe symptoms which may require surgery. Ulcerative colitis affects the large bowel (colon and rectum), and causes loose motions, bloody diarrhoea, bleeding and mucus. Crohn's can occur anywhere through-out the small or large bowel, but is often centred on the terminal ileum (end of the small bowel, just before it joins the colon), where it can cause right lower abdominal pain and a mass. Treatment of IBD is initially with medications, typically anti-inflammatory drugs or steroids. We work closely with our medical colleagues to optimise the care of patients with IBD.
Stomas
No one wants a colostomy or ileostomy (stoma bag), but sometimes it is necessary to ensure the correct and safe treatment for major bowel conditions. Almost everyone who has to have one finds they are easier to manage than expected. We can provide a lot of support, and we have excellent stoma care therapists, both at Frimley and privately (Debbie Cottrell). There are also very good local and national stoma organisations, including the Colostomy Association and Stomawise.
For more information:
colostomyuk.org
acpgbi.org.uk/_userfiles/pages/files/procedures/havingastoma.pdf