A hernia appears as a lump, most commonly in the abdominal or groin area. They occur when an organ, often the bowel, protrudes through the cavity which normally contains it.
Haemorrhoids, commonly known as piles, are swollen veins in the anus or lower part of the rectum. They are a very common ailment. Haemorrhoids may be either internal or external. External haemorrhoids generate protuberances in the ring of the anus on the outer side, making them easier to diagnose and can cause pain when sitting, in addition to traces of blood when defecating. On the other hand, internal haemorrhoids occur inside the anus causing bleeding in the stool and itching in the anal region.
The main symptoms of haemorrhoids are:
Haemorrhoids occur due to increased pressure in the anus. They can be caused by:
To prevent haemorrhoids, it is necessary to avoid constipation. For this reason, it is important:
In the case of external haemorrhoids, the treatment consists of applying creams and warm water in the affected area. In cases of severe pain, you can take painkillers. As for internal haemorrhoids, surgical intervention may be necessary to remove them.
An anal fistula is small channel or tunnel that develops between the end of the bowel and the skin near the anus (i.e. where stool leaves the body). These can result in bleeding when passing stool and cause pain and discomfort. Often anal fistulas won’t get better on their own and will usually require treatment. Surgery is a common recommendation for treating anal fistulas.
The most common symptoms of an anal fistula are:
Anal fistulas are usually a result of an anal abscess that has not healed properly. When an anal abscess has not healed properly, the pus has drained away, but leaves a channel or tunnel behind. It is common for an anal abscess to result in anal fistula.
Other causes of anal fistulas include:
As anal fistulas usually do not heal on their own, surgery is often required. There are numerous types of surgery, including:
Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques. Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field.
Endoscopy is the use of cameras to relay images from inside the body. The device used, known as an endoscope, is a long thin flexible tube with a camera at one end and a light source.
Endoscopes are inserted in to the body via a natural opening such as the mouth or the anus. There are different types of endoscopy depending on the site and function of the procedure – if the bowel is to be investigated for example, it is referred to as a colonoscopy. If the airways are to be examined, the procedure is referred to as a bronchoscopy.
Endoscopy can also be used for surgery, as in the case of laparoscopic surgery – in this situation the laparoscope (a specific type of endoscope) is inserted through small incisions. Once inserted, the endoscope is able to send images from the inside of the subject’s body back to a TV screen.
Endoscopy is most commonly used to investigate symptoms and help to diagnose conditions relating to the digestive system, although it can be deployed to produce images and aid with many other parts of the body, including the respiratory system, the urinary tract and the female reproductive system. An endoscope can also be used to assist with surgery.
An endoscopy is commonly used to investigate symptoms such as abdominal pain, nausea and vomiting, unexplained weight loss, diarrhoea, blood in the stool or vomiting blood.
You may be required to avoid food and liquids for a period beforehand, depending on what type of endoscopy you are undergoing. In the case of a colonoscopy, you might be given laxatives to help you evacuate any stool beforehand. You may also be required to stop taking certain medication such as blood thinners to prevent excess bleeding from the procedure.
The procedure usually only causes mild discomfort although a local anaesthetic is also sometimes used. It is normally performed with the patient conscious, although sedatives can be deployed to help you relax. Antibiotics are sometimes used to reduce risk of infection.
An endoscopy can be used to diagnose a wide range of conditions and the results are interpreted by a specialist. Whether the results are good or bad clearly depends on what symptoms are being investigated and on which part of the body the endoscopy is being performed.
Colorectal cancer begins with a polyp that develops in the colon or rectum. When this polyp is covered with adipose tissue it can change into an adenoma, a specific type of polyp, or adenocarcinoma, a type of cancer that contains mucus and other fluids. The tests to detect colon cancer are usually carried out through colonoscopy, a test that introduces a thin and flexible tube with a camera (endoscope) into the anus, and virtual colonoscopy, a radiological examination that obtains images. The purpose of these tests is to determine the presence of adenomas and polyps in the colon and to surgically remove them before they become cancerous.
Mr Charles Evans is a leading consultant general surgeon and one of a small number of UK surgeons specially trained in robotic surgical techniques. Working across Leamington Spa and Coventry, Mr Evans has a wide practice covering hernia surgery, diagnostic and interventional endoscopy, bowel resection for cancerous and non-cancerous conditions, anal fissure and fistula, haemorrhoids, and appendix removal. Following paediatric surgical training through experience working in the Oxford Paediatric Surgical Department and at the Royal Berkshire Hospital, Mr Evans also performs general paediatric surgery including procedures such as hernia and hydrocele repairs, and circumcisions.
Mr Evans completed basic surgical training in London and was awarded an MD from the University of London following research into colorectal cancer and minimally invasive surgery. He undertook higher surgical training at the Oxford Deanery following which he was selected for the National Ethicon Fellowship in Advanced Colorectal Surgery. He completed his training with a further fellowship in complex colorectal surgery at St Mark's Hospital, London. He has an interest in perianal conditions including haemorrhoids, fistula, and fissures. He performs laparoscopic and open hernia repairs and holds specialist accreditation for therapeutic colonoscopies.
Mr Evans continues to have an active role in surgical research, presenting at national and international conferences. He is a regular reviewer for journals including the British Journal of Surgery and Colorectal Disease, and at UHCW he is heavily involved in research focusing on early cancer detection and advances in robotic surgical techniques.
Abdominal pain can be a symptom of many conditions. It is the name given to pain that radiates between the chest and the groin. The most common cause is: constipation, irritable bowel syndrome, food allergies or intolerances, or food poisoning. There are different types of abdominal pain, including:
Condition prognosis depends of the cause of the abdominal pain. The causes may range from simple issues such as excess gas to more complicated conditions such as appendicitis or kidney stones. When a person has abdominal pain, the cause of it must be looked at thoroughly to be able to properly treat it. There are some symptoms which may be a sign of a more serious condition, such as:
Different symptoms may indicate what is causing the abdominal pain. It may simply be due to indigestion, however when the pain is strong, it may be due to a more serious issue with the appendix, the gallbladder, the pancreas, or the kidneys among others.
Different tests can be carried out to determine the cause of abdominal pain:
There could be many causes for abdominal pain, it is important to find the cause and seek medical attention as soon as possible. The most common causes for abdominal pain include:
Abdominal pain can be prevented by following a healthy and balanced diet, and eating small meals often. This will help digestion. It is also important to maintain a healthy weight and to exercise regularly. Stress in known as a cause of cramps and nausea.
Treatment will depend on the cause and location of the pain. The specialist will recommend what treatment should be used after careful examination. Treatment to treat mild causes include:
Generally, the specialist who treats abdominal pain is a gastroenterologist. Digestive system specialists study the digestive tract including the oesophagus, stomach, small intestine, colon, rectum, anus, as well as the liver, gallbladder, and pancreas. This specialty treats common issues and pathological issues. It treat conditions that may affect other parts of the body and other organs.
An anal abscess is an infected, pus-filled cavity near the anus, often appearing as a painful, boil-like swelling. They are most commonly small anal glands that have become infected.
Superficial anal abscesses usually cause one or more of the following symptoms:
Deeper abscesses may cause further symptoms, such as:
There are different causes of anal abscess:
In addition, there are certain factors that can increase the risk of anal abscess:
Some of the causes, such as diabetes and Crohn’s disease are difficult or impossible to prevent. However, one can take precautions to minimise the risk of developing anal abscesses, such as using a condom during anal sex or getting any soreness of the anal area checked out immediately, so that blocked anal glands or anal fissures can be identified and treated before they become infected.
In the case of infants and young children, frequent nappy changes and cleaning the child’s anal area properly can help prevent anal abscess and fistulas.
An anal abscess will not disappear on its own, so the patient must see a doctor to drain the abscess. The patient usually goes home on the same day of the procedure, although larger abscesses may require hospitalisation and the assistance of an anaesthesiologist.
The doctor may prescribe pain medication for after the procedure. Patients with certain conditions like diabetes or a weak immune system may also be given antibiotics. Patients are advised to bathe the area with warm water e.g. in a bath three or four times a day.
Either at the same time as the abscess is drained or in the weeks following the procedure, the patient may also need fistula surgery to repair the hole or tunnel left behind once the abscess is drained.
What is an anal fissure?
An anal fissure (fissures) is a tear or crack in the lining of the anal canal (anus), which causes extreme pain during bowel movements. Anal fissures affect everyone, from men and women to young and old people. It is the most common cause of rectal bleeding in infancy. A fissure tends to occur when passing hard or large stools during a bowel movement. There may also be spasms in the ring of muscle at the end of the anus.
What is the cause of an anal fissure?
Common causes of an anal fissure include passing large stools, constipation and straining during bowel movements, chronic diarrhoea, inflammation of the anorectal area and childbirth. The less common causes of anal fissures include anal cancer, HIV, tuberculosis, syphilis and herpes.
What are the symptoms of an anal fissure?
The symptoms of an anal fissure include:
How is an anal fissure treated?
An anal fissure will often heal within a few weeks if the stool is kept soft through increasing the intake of fibre and fluids. Soaking in a warm bath for 10 to 20 minutes daily, especially after toilet use, helps to relax the sphincter and helps it to heal. A doctor may recommend topical anaesthetic creams for pain relief. A Botox (Botulinum toxic type A) injection can paralyse the anal sphincter muscle and aids in relaxing spasms. Blood pressure medications can also help relax the sphincter.
How to prevent an anal fissure?
By preventing constipation it may help in preventing an anal fissure. Constipation can be prevented when eating high-fibre foods, drinking water and regularly exercising to stop from straining during bowel movements.
Risk factors for developing an anal fissure
An anal fistula is small channel or tunnel that develops between the end of the bowel and the skin near the anus (i.e. where stool leaves the body). These can result in bleeding when passing stool and cause pain and discomfort. Often anal fistulas won’t get better on their own and will usually require treatment. Surgery is a common recommendation for treating anal fistulas.
The most common symptoms of an anal fistula are:
Anal fistulas are usually a result of an anal abscess that has not healed properly. When an anal abscess has not healed properly, the pus has drained away, but leaves a channel or tunnel behind. It is common for an anal abscess to result in anal fistula.
Other causes of anal fistulas include:
As anal fistulas usually do not heal on their own, surgery is often required. There are numerous types of surgery, including:
An anal fistula is a tunnel or channel that develops between the skin near the anus and the bowel. This can have a number of unpleasant symptoms, and surgery, known as anal fistula surgery, is often undertaken to correct this. It is performed under general anaesthetic.
Anal fistula surgery is usually needed to treat anyone suffering from an anal fistula as they are unlikely to heal on their own. Anal fistulas are normally the result of an abscess around the anus, which when drained of the pus, leaves a small channel behind it.
Anal fistulas can be extremely unpleasant, and often cause discomfort. Surgery is nearly always required.
Anal fistula surgery is carried out under general anaesthetic. There is more than one possible procedure and the most suitable will depend on individual cases.
Fistulotomy:
Seton techniques:
Advancement flap procedure:
Leading up to the surgery, it might be necessary to stop taking certain medications. It is also likely that you will need to empty your colon with either a laxative or an enema before surgery. You will also need to stop eating and drinking a certain period prior to surgery. It is recommended that you have someone to drive you home after surgery.
It is to be expected that there will be some bleeding and pain with your first bowel movement after surgery. It can help to make this less painful by adopting a high-fibre diet and taking stool-softeners the first few days after surgery.
Most patients will return to normal activities 1 to 2 weeks after surgery, but it will taken several weeks or a few months for the fistula to fully heal, depending on the individual case.
Here are some key post-operative care things to do after having anal fistula surgery:
Appendicitis is an inflammation of the appendix, which is a small pouch of tissue attached to the colon, located in the lower right abdomen. It is formed at the junction of the small and large intestines.
A sudden pain around the middle of the abdomen that moves to the lower right abdomen or a pain in the lower right abdomen (where the appendix is located) are common symptoms of appendicitis. Other symptoms include nausea, vomiting, loss of appetite, diarrhoea and a fever. A pain that becomes worse all of a sudden and spreads across the abdomen is a sign that the appendix may have burst and requires immediate medical attention.
Appendicitis is caused by a blockage or obstruction in the appendix that leads to infection. The appendix gets filled with a build-up of mucus, causing swelling.
Appendicitis is very hard to prevent, although there is evidence that it is less prevalent in people with high fibre diets.
Appendicitis can lead to the appendix rupturing, which is a very dangerous complication and it is important to prevent the condition reaching this stage.
A ruptured appendix spreads potentially life-threatening infection. Peritonitis occurs when the peritoneum (tissue which lines the abdomen) becomes infected and can cause long-term problem and even death.
In most cases, the appendix is removed by surgery. The operation is referred to as an appendectomy and is performed to prevent the appendix from bursting. The operation is performed as either open or keyhole surgery.
Keyhole surgery is preferred over open surgery and will be carried out where possible. Keyhole, or laparoscopic, surgery is less invasive than open surgery and has shorter recovery times. Several small incisions are made in the abdomen, which is then inflated with a gas to make it easier to perform the surgery. The operation is done with the aid of a laparoscope, which is a small tube with a camera that relays images back to the surgeon.
In cases where the patient has previously had abdominal surgery or the appendix has already burst in might not be possible to perform keyhole surgery. In these cases, open surgery might be preformed, which consists of a single, much larger cut in the lower right abdomen.
If the appendix has burst and an abscess has formed, it will be necessary to drain the abscess before performing an appendectomy.
Bowel cancer, also known as colorectal cancer, originates from the development of tumour cells in the mucosa of the bowel. Given that the colon and the rectum are connected, the cancer often develops in one area and spreads to the other: that is why it is also called colorectal cancer.
It has been estimated that this type of cancer is the third largest cause of death in developed countries, and is more common in men than in women. Even though it is a fairly widespread cancer, if detected early survival rate is around 80%.
The main symptoms of colorectal cancer include:
However, these symptoms can be very mild and can be confused with symptoms for other conditions. That is why you should always pay attention to possible signs such as fatigue (asthenia), loss of appetite and anaemia.
This condition can be diagnosed with exams such as colonoscopy, sigmoidoscopy, or a colorectal X-ray scan.
One of the main causes of colorectal cancer is genetic predisposition. If there’s a family history of cancer or polyps, your possibility of getting this cancer increases by as much as four times.
An unhealthy diet and a sedentary lifestyle can also lead to developing this type of cancer. The same goes for smoking and excessive alcohol consumption. Finally, chronic inflammatory disease of the bowel can also increase your risk of getting colorectal cancer.
You cannot completely prevent bowel cancer but you can take steps to reduce your risk. According to the latest research, some foods and drink may increase your chances of getting bowel cancer. These include: red meat, processed meat and alcohol. Being overweight or obese can also lead to bowel cancer. On the other hand, an active lifestyle and eating a diet rich in fibre, garlic and milk seems to have a positive effect on bowel health.
If detected early (when the cancer is still restricted to one area), the most effective treatment consists in surgically removing the tumour cells. If your doctor thinks there may be further tumour lesions, after surgery you may get started on chemotherapy. If the cancer is already in its more advanced stages, treatment will be more complex, possibly involving radiotherapy and/or further chemotherapy sessions.
For screening exams, you should see a gastroenterologist. Should you be diagnosed with colorectal cancer, you will need to see an oncologist and a general surgeon.
Bowel incontinence describes a loss of control over bowel movements, leading to the patient unintentionally soiling themself. It is thought that as many as one in ten people will experience some degree of bowel incontinence in their lifetime, and is nothing to be ashamed of. It is usually symptomatic of another problem or underlying condition, and is not a normal part of ageing. It usually won’t just go away on its own, but it can be treated effectively, and often cured, so it is always best to consult your GP or a specialist.
Bowel incontinence itself is usually a symptom, not a diagnosis. It may occur as a sudden need to go to the toilet, but the patient may not make it in time (urge bowel incontinence). However, other patients have no warning before they soil themselves, feeling no sensation as the stool passes (passive incontinence/passive soiling). Passing wind may also cause slight soiling.
Most cases of bowel incontinence are brought on by bouts of diarrhoea, or conversely, constipation. Another common cause is weakening of the anal sphincter (the ring of muscle that opens and closes the anus).
Long-term causes, such as diabetes, multiple sclerosis, spina bifida, and even dementia can also cause bowel incontinence.
Maintaining a healthy diet and lifestyle can help to reduce the chances of getting diarrhoea or constipation, which are the leading causes of bowel incontinence. This can also stave off type 2 diabetes. However, there is no guarantee of preventing these problems, and there is nothing that can be done to prevent causes such as MS or dementia.
Luckily, bowel incontinence is highly treatable, enabling most patients to maintain normal bowel function for the rest of their lives. Different treatments include:
In many cases, incontinence can be cured, but even if not it is usually possible to improve bowel control to some degree, and significantly improve the symptoms.
What is a colectomy?
Colectomy is a surgical procedure that involves the removal of all, or the partial sectioning, of the large intestine (colon). The colon is a long tube-shaped organ at the end of the digestive tract. A colectomy is necessary to treat or prevent diseases and conditions that affect the colon.
Diseases and conditions treated with a total or partial colectomy
The following conditions may require a colectomy:
Different types of colectomy operations
A total colectomy removes the entire large intestine. A partial colectomy, also known as a subtotal colectomy, removes only part of the colon. A hemicolectomy removes either the right or the left portion of the colon and a proctolectomy removes both the colon and the rectum.
Open vs. laparoscopic procedure for colectomy
During an open colectomy, a long incision is made in the wall of the abdomen and doctors can see the colon. In a laparoscopic-assisted colectomy, a lighted tube with a video camera is in inserted through one of several small incisions to guide the surgery.
Risks of a colectomy
The procedure carries a risk of serious complications, which depend on the patients' general health and the type of colectomy used to perform the operation. These complications can include:
How to prepare for a colectomy
In the days leading up to the colectomy, the doctor will suggest that the patient stops taking certain medications. Fasting before surgery is also required and drinking a solution such as a laxative that clears your bowels. In some cases, a doctor may prescribe antibiotics to prevent any infection from occurring.
The term chronic diarrhoea is used for cases in which diarrhoea has lasted for several weeks and is quite often linked to other health issues such as weight loss, abdominal pain, vomiting, nausea, high temperature or fever, or being unable to absorb nutrients.
Diarrhoea is the frequent passage of soft and watery stools. It is thought to be frequent if a person has bowel movements more than three times a day.
Diarrhoea can be a relatively common issue that normally lasts a few days before going away on its own. When it lasts longer, it may be due to a more serious issue. In cases of chronic diarrhoea, symptoms can come and go.
Diarrhoea continues to be one of the main causes of morbidity and mortality in underdeveloped countries, affecting up to 5% of the world’s population. Risk factors include malnutrition and lack of breast milk, among many others.
It is worth noting that the prevalence of chronic diarrhoea is much lower in the western world, and deaths that arise from it tend to be isolated cases derived from untreatable congenital diarrhoea.
The patient's medical history is important for the initial diagnosis and choice of tests.
Anamnesis: a medical history of foods that have previously lead to diarrhoea. The faeces are analysed which can quite often indicate a cause.
Physical examination: signs of malabsorption and malnutrition are looked for: weight, size, body mass index, muscle mass, and many more. It is useful to note the changes from the onset of diarrhoea. During the examination, things such as hydration levels and changes in skin tone will be taken into account.
Additional tests: these tests vary depending on the patients’ age and diagnosis. The more basic tests will be done first to diagnose more frequent causes.
There are many things that could cause diarrhoea, the most common are:
To avoid viral diarrhoea, it is important to maintain good hygiene such as washing your hands with soap and water before and after meals.
To avoid bacterial or parasitic diarrhoea, it is important to have good food hygiene and to drink clean or bottled water. It is also important to have good hand hygiene as with viral diarrhoea.
In cases of diarrhoea after eating, it can sometimes be due an intolerance, which is quite difficult to prevent when unknown.
Another type is travellers’ diarrhoea, the recommendation for avoiding this is to avoid undercooked or raw food as well as cold drinks with ice. It is advisable not to drink tap water and to eat foods which have been thoroughly cooked.
Treatment will depend on the cause and the severity. One of the most important things to do is to compensate for the loss of liquids and minerals. The easiest way to do this is is to increase the amount of liquid ingested with mineral water, herbal teas, or drinks that have sodium, chloride, or potassium.
If the diarrhoea is intense, increasing the water ingested should help alleviate the problem. If it’s not possible to keep liquids down for very long, it’s recommended that you go to the doctor to get electrolytes and water replenished intravenously.
As it is a relatively common symptom, there are many specialists who could treat and solve chronic diarrhoea problems. Specialists include; gastroenterologists, internal medicine, and family medicine specialists, occasionally surgeons can help treat diarrhoea or chronic diarrhoea.
What is colitis?
Colitis refers to the inner lining of the colon becoming inflamed. Colitis can be a symptom of a disease that affects other parts of the body, which causes fevers, chills, fatigue and dehydration. There are many types of colitis that are usually classified by the cause of each one. The two most common types include ulcerative colitis and Crohn’s disease, which are types of inflammatory bowel disease (IBD). Ulcerative colitis causes other manifestations in the body, which include mouth ulcers, swelling of the joints and skin inflammation.
What are the different types of colitis?
The types of colitis are categorised by what causes them. Some of the different types include:
• Ulcerative colitis and Crohn’s disease – these two types of colitis are classified as inflammatory bowel disease. Ulcerative colitis occurs when the immune system overreacts to bacteria in the digestive tract. It begins in the rectum and spreads to the colon.
• Pseudomembranous colitis – this type of colitis occurs from the overgrowth of a bacteria known as Clostridium difficile. Normally found living in the intestine, this bacteria does not usually cause problems because of the balance with the good bacteria. Clostridium difficile takes over when medications such as antibiotics destroy the good bacteria. The toxins that are released cause inflammation.
• Ischemic colitis – this occurs when the blood flow to the colon is cut off or restricted.
What causes colitis?
The most common causes of colitis include:
• Infections or viruses
• Loss of blood supply
• Chronic diseases
• Allergic reactions
What are the signs of colitis?
The symptoms of ulcerative colitis may include:
• Diarrhoea
• Abdominal pain and cramps
• Rectal pain
• Rectal bleeding – experiencing a small amount of blood in the stool
• Desperate to use the toilet
• Inability to defecate even though there is a feeling of urgency
• Weight loss
• Fatigue
• Fever
How is colitis diagnosed?
A physical examination by a specialist helps to determine the cause of a patient’s symptoms. The doctor will take the patient’s blood pressure and check their temperature for fever. There is an examination of the abdomen to check if there is a feeling of tenderness. Bowel sounds are listened to through the use of a stethoscope. A blood test can measure haemoglobin and haematocrit levels to check for anaemia. Stool samples may also be collected to search for bacterial and parasitic infections as the cause of colitis. The stool may be tested for blood too.
How is colitis treated?
The treatment of colitis depends on how bad the disease is within the individual patient. Treatment usually involves a change in diet, nutritional supplements and medication being prescribed. In severe cases, surgery may be required. Mild colitis responds to medicines such as steroids and anti-inflammatories. More severe symptoms will require stronger medication such as immunomodulator medicines, which suppress the immune system to prevent inflammation. Surgery may be required to remove the large intestine, however this can cause other problems in different areas of the body.
Foods to avoid:
• Alcohol and fizzy drinks
• Caffeine
• Dairy products
• Raw fruits and vegetables
• Legumes
Foods to incorporate into the diet:
• Omega-3 fatty acids (found in salmon)
• Probiotics (kefir)
• Iron-rich foods (green vegetables)
• Turmeric
• Folate-rich foods
Colon cancer is the proliferation of malignant cells in the colon, which, along with the rectum, is in charge of storing faeces which are then expelled through the anus. Its causes are determined by genetics, sedentary lifestyle and previous illnesses such as polyps, ulcerative colitis and other cancers. The most obvious symptoms of the disease become visible when the disease is advanced: alternating between diarrhoea and constipation, blood in the stool, abdominal pain, loss of appetite, weight loss and fatigue. If detected early there is a good chance of cure, with the most common treatments being radiotherapy, chemotherapy, immunotherapy to strengthen the body's defences, and surgery.
A colonoscopy is a type of endoscopy that is used to examine the colon and small intestine in order to detect any abnormalities (inflammation, ulcers, etc.). The procedure usually lasts around 15-20 minutes.
It is performed using a thin tube (endoscope) that is inserted through the anus and has a video camera at the end to record the organs and walls it passes through.
A colonoscopy may be performed for various reasons:
Before the test you should follow instructions for cleansing the bowel to make it easier for the doctor to observe it. This will involve drinking only liquids in the 24 hours before the procedure, and taking a solution that will help you empty your bowels.
During the procedure, you will be partially or fully sedated. You will be placed on your side and the doctor will insert the endoscope through the anus to pass through your large intestine.
A colonoscopy is usually well tolerated and is rarely painful. At most, you will feel pressure, swelling, or cramping during the procedure. Less than one per cent of patients will experience serious complications.
If the specialist feels that a more accurate evaluation is necessary, they will obtain a biopsy of the lining of the bowel for analysis.
If polyps are found during the procedure, these can be removed straight away.
There is now an alternative to traditional colonoscopy that is much less invasive and does not require sedation. This is called a virtual colonoscopy, which is an examination that uses images of the inside of the bowel and colon obtained by means of computerised tomography (CT or CAT scan) instead of images taken by the colonoscopy camera.
Colorectal cancer begins with a polyp that develops in the colon or rectum. When this polyp is covered with adipose tissue it can change into an adenoma, a specific type of polyp, or adenocarcinoma, a type of cancer that contains mucus and other fluids. The tests to detect colon cancer are usually carried out through colonoscopy, a test that introduces a thin and flexible tube with a camera (endoscope) into the anus, and virtual colonoscopy, a radiological examination that obtains images. The purpose of these tests is to determine the presence of adenomas and polyps in the colon and to surgically remove them before they become cancerous.
Colorectal cancer, also known as bowel cancer, is the cancer of the large intestine (colon). The large intestine makes up the end of the digestive tract, and cancer usually starts as a cluster of cells called polyps. Not all polyps are cancerous, and therefore it is important to closely monitor them and have them removed before they become cancerous.
Colorectal cancer surgery involves the removal of the cancerous part of the colon, which is known as a colectomy. Depending on what stage the cancer is at, surgery can range from minimally-invasive polyp removal, to the removal of both the colon and rectum. Depending on the type of surgery, local or general anaesthetic will be used.
If colorectal cancer is identified early on, surgical treatment can often cure the cancer and prevent it from returning, however, this is not always possible. Surgery is often combined with other treatments such as chemotherapy and radiotherapy.
Exact causes of colorectal cancer are unknown, however, there are associated risk factors that can increase the likelihood of developing it. These include:
Surgery for early-stage colorectal cancer usually involves the removal of a small section of the colon lining. This is called a local excision.
However, if the cancer has spread into the surrounding muscle, a whole section of the colon will need to be removed. This is called a colectomy. Colectomies can be carried out in the following ways:
Whilst surgery is carried out, it is common for nearby lymph nodes to be removed as well and will be tested for cancer. During a colectomy, the surgeon will reconnect the healthy parts of the colon. If these cannot be reconnected, then the surgeon will have to carry out stoma surgery. This diverts the faeces away from the colon towards an opening in the abdomen and into a stool bag that is fitted to the opening. The stoma will either be temporary or permanent, depending on how well the colon heals after surgery.
Depending on the type of surgery, you might be required to a follow a special diet before surgery, or to empty your bowels. On the day of surgery, you won’t be able to eat or drink. It is common that prior to surgery you will be given a dose of antibiotics to prevent the possibility of infection.
If you are going to have a stoma, then you will have met a stoma specialist to explain how they work.
Immediately after surgery, the care team will try to get you moving to prevent blood clotting. It is common to expect some pain and nausea. Patients can generally return home in around three to seven days after surgery, and a check-up appointment would be booked in to discuss recovery and any further treatment required.
Colorectal surgery is a field in medicine that treats conditions of the colon, anus and rectum. Sometimes treatment involves a team of specialists to treat conditions that affect numerous areas of the body. The conditions treated within the field of colorectal surgery vary and include:
You would see a colorectal surgeon if you were being diagnosed or treated for the above conditions, as well other conditions relating to the colon, anus and rectum.
What does colorectal surgery involve?
The different surgical procedures carried out by colorectal surgeons include:
Much of the above diagnostic and surgical procedures are carried out under local or general anaesthetic and involve a hospital stay of some description. Minimally invasive techniques (laparoscopy, colonoscopy) generally allow for faster recoveries and fewer complication risks, however, whether or not your condition can be treated in such a way depends on the circumstances surrounding your diagnosis.
The term “constipation” refers to infrequent bowel movements or difficulty passing stool. Constipation is usually defined as when a patient makes less than three bowel movements a week. These bowel movements may be difficult, even painful, and the individual may strain themselves trying to go.
Occasional constipation is common, and can be related to change of routine, going on holiday, or while taking medication. The body usually readjusts quickly and normal defecation rhythm is resumed. However, some people experience chronic (ongoing) constipation, which may require an examination by a doctor to rule out an underlying illness.
The key symptoms of constipation are:
Constipation can also cause general discomfort, with sufferers feeling bloated, sick, or getting stomach aches. Some patients cause further discomfort by straining to push stools out. If the patient successfully defecates, they may feel as though they haven’t completely emptied their rectum.
There are many possible causes of constipation in adults, and sometimes there is no obvious cause.
Common causes include:
Constipation is relatively common during and up to six weeks following pregnancy. In rarer cases, it may be caused by an underlying medical condition.
Such conditions include:
Leading a healthy lifestyle, with a diet rich in fibre can help prevent constipation. It is also advisable to drink plenty of fluids (about two litres of water a day), exercise regularly and go to the bathroom when you feel the urge to defecate, instead of holding it.
In most cases, lifestyle changes will resolve the problem:
If these measures don’t work, the doctor may recommend laxatives to help stimulate bowel movements.
Crohn’s disease is a type of chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract from mouth to anus, but is most commonly found at the end of the small intestine, where this meets the colon (large intestine). It is characterised by inflammation, which is often severe and can be debilitating, and may extend through the whole width of the bowel wall.
Crohn’s is a chronic condition, meaning long-term. There is currently no known cure for Crohn’s disease, although existing therapies make it manageable and can cause the disease to go into remission for years at a time. Flare-ups still occur periodically, however, and can make life difficult.
When Crohn’s disease is active, typical symptoms include:
Symptoms can range from mild to severe, and usually develop gradually, but may come on in sudden attacks.
In severe cases, Crohn’s can also affect other parts of the body, including inflammation in the joints, the liver, the skin, and the eyes.
Crohn’s can start at any age, but symptoms usually first manifest in late childhood and early adulthood, with the majority of cases being diagnosed before the age of 30.
It often occurs in flare-ups, which may go into remission with treatment, but will flare up again weeks, months, or even years later.
The causes of Crohn’s disease are currently poorly understood, but a great deal of research into the illness is being carried across the world and experts are continuing to learn a lot about its mechanisms and possible causes. The leading theories are that it is caused by a combination of some of the following factors:
Other risk factors that may contribute include:
While Crohn’s disease cannot be cured, there are treatments to reduce and control the symptoms. Sometimes, these treatments can be enough to send the disease into periods of remission. Typical treatment options include:
Gastroenterologists treat all kinds of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis. Colorectal surgeons are usually responsible for performing operations to treat IBD.
Diarrhoea is characterised by a greater fluidity and volume of bowel movements. These stools can sometimes contain blood, mucus, pus and undigested food.
When diarrhoea lasts for many days, it can be a sign of a more serious problem. Chronic diarrhoea that lasts for at least four weeks can be a symptom of a chronic disease.
The main symptoms of diarrhoea, in addition to greater fluidity and volume of the stools, are:
If the cause of the diarrhoea is due to a virus or bacteria, other symptoms such as fever, chills and blood in the stool may appear.
In addition, diarrhoea can cause dehydration.
The most common causes of diarrhoea are:
Sometimes a specific cause is not found. If the diarrhoea disappears after a couple of days it is generally not necessary to investigate further.
Two types of diarrhoea can be prevented: rotavirus diarrhoea and traveller’s diarrhoea. In the first case, there are vaccines available for rotavirus. As for traveller’s diarrhoea, it is important that when travelling, we are careful with the food and beverages we consume in certain countries or in certain regions. Speak to your doctor before going on holiday for advice on avoiding traveller’s diarrhoea. It can help to avoid eating raw fruits and vegetables, and to only drink bottled water.
The main objective of the treatment for diarrhoea is to replenish fluids and electrolytes lost due to dehydration. Depending on the cause, your GP or specialist may prescribe a pharmacological treatment to either stop the diarrhoea or treat the infection.
Diverticular disease is characterized by the presence of diverticula in the colon wall, due to an increase in intraluminal pressure. Diverticula are pockets that usually form on the left side of the colon walls, although it can occupy the entire colon. When an increase in intraluminal pressure produces a pulse of the muscosa occurs through colonic muscle layers in their weak points, which correspond to the points where the neurovascular bundles penetrate. In most cases, diverticular disease have no symptoms, and only when there is bleeding or complications may appear diverticulitis. Diverticulitis (that is infection of the diverticula) in turn can cause abdominal pain, fever and chills. More serious complications can even cause an ruputura or fistulae that require surgery. The treatment of diverticular disease is essential and based on regular consumption of dietary fiber. In the case of diverticulitis, treatment should be done by antibiotics (oral or intravenous), restrictions on food and stool softeners.
Diverticulitis is a condition affecting the large intestine, or bowel. It is closely related to another condition affecting the bowel, called diverticular disease. Diverticulitis is more likely to occur in those who do not get enough fibre through their diet.
As we get older, small pockets or bulges called diverticula may develop in the lining of the intestine. These do not often cause symptoms and can go entirely unnoticed, but when they do cause symptoms, this is referred to as diverticular disease. Once symptoms become more severe, and the diverticula become infected, or inflamed, this is referred to as diverticulitis.
Diverticulitis symptoms include:
If you experience symptoms of diverticulitis, without any previous diagnosis of diverticular disease, you should contact your GP as soon as possible. If you have a previous diagnosis of diverticular disease the symptoms can be managed and treated from home. However, if you notice bleeding, or are experiencing severe pain, it is best to seek medical attention.
Your doctor will take your medical history and make an assessment of your symptoms. This is because they will want to rule out other conditions which can display similar symptoms, such as IBS (irritable bowel syndrome), or bowel cancer.
The doctor may also take blood tests and refer you for a colonoscopy or CT scan.
Diverticulitis is most commonly treated at home using medication to relieve symptoms of pain, and antibiotics. In more severe cases, diverticulitis can be treated at the hospital so the doctor can monitor your progress and symptoms. Treatment in hospital may involve antibiotics administered through injections, and an intravenous drip to provide hydration and nourishment.
If you have already been diagnosed with diverticular disease, a high-fibre diet may help to ease any symptoms you experience with the condition. The ideal amount of fibre for an adult is 30g per day, and your doctor will discuss targets and ways to include fibre in your diet.
In more extreme cases, diverticulitis can be treated with surgery. This type of treatment is rare, and it involves removing the affected section of intestine. However, before any type of surgery, your surgeon will discuss the benefits and risks implied.
Endoscopy is the use of cameras to relay images from inside the body. The device used, known as an endoscope, is a long thin flexible tube with a camera at one end and a light source.
Endoscopes are inserted in to the body via a natural opening such as the mouth or the anus. There are different types of endoscopy depending on the site and function of the procedure – if the bowel is to be investigated for example, it is referred to as a colonoscopy. If the airways are to be examined, the procedure is referred to as a bronchoscopy.
Endoscopy can also be used for surgery, as in the case of laparoscopic surgery – in this situation the laparoscope (a specific type of endoscope) is inserted through small incisions. Once inserted, the endoscope is able to send images from the inside of the subject’s body back to a TV screen.
Endoscopy is most commonly used to investigate symptoms and help to diagnose conditions relating to the digestive system, although it can be deployed to produce images and aid with many other parts of the body, including the respiratory system, the urinary tract and the female reproductive system. An endoscope can also be used to assist with surgery.
An endoscopy is commonly used to investigate symptoms such as abdominal pain, nausea and vomiting, unexplained weight loss, diarrhoea, blood in the stool or vomiting blood.
You may be required to avoid food and liquids for a period beforehand, depending on what type of endoscopy you are undergoing. In the case of a colonoscopy, you might be given laxatives to help you evacuate any stool beforehand. You may also be required to stop taking certain medication such as blood thinners to prevent excess bleeding from the procedure.
The procedure usually only causes mild discomfort although a local anaesthetic is also sometimes used. It is normally performed with the patient conscious, although sedatives can be deployed to help you relax. Antibiotics are sometimes used to reduce risk of infection.
An endoscopy can be used to diagnose a wide range of conditions and the results are interpreted by a specialist. Whether the results are good or bad clearly depends on what symptoms are being investigated and on which part of the body the endoscopy is being performed.
An epigastric hernia is when fat or body tissue protrudes through the abdominal wall, between the sternum of your rib cage and your belly button. Often there are no symptoms with this type of hernia and they often go unnoticed. This type of hernia is usually small and you can have more than one at a time. Despite showing few symptoms, they can sometimes cause pain in the upper abdominal region.
Although symptoms with an epigastric hernia are uncommon, a noticeable bulge might present especially when you cough, sneeze, laugh or strain. Sometimes this type of hernia can cause pain and tenderness in the affected area.
This type of hernia is usually present from birth due to incomplete abdominal wall development.
These hernias do not heal themselves and surgery is required to repair them. However, unless the hernia becomes an emergency surgery can be delayed until the patient feels ready, or when a child becomes older. Often when adults are diagnosed with an epigastric hernia, it has become problematic due to obesity, muscle weakness or frequent strain on the abdominal wall due to heavy lifting or straining.
Surgery can be peformed either openly, or laparoscopically. General anaesthesia is used. If the defected muscle opening is small then sutures usually suffice to close the hole. However, for larger muscular defects, an inserted mesh might be needed to restore strength to the abdominal wall. Such a mesh is permanent and stops the hernia from returning.
Most patients are able to return to their normal activities within two to four weeks following surgery.
A femoral hernia is fairly uncommon and is most commonly found in women. Femoral hernias are found in the groin region and can appear as a painful lump on the inner, upper thigh. The lump can be pushed back in and can sometimes become more prominent when straining or coughing. It is estimated that only 1 in 20 groin hernias are femoral hernias, and are mostly inguinal hernias. They are more common in women because women have a wider pelvis.
Some people with a femoral hernia do not notice any bulge, lump or pain, however, larger femoral hernias produce a visible bulge in your upper thigh which can be painful, especially when straining.
A femoral hernia is the result of fatty tissue or a section of the bowel protruding through into the groin on the top of your inner thigh. The section where the protrusion can occur is called the femoral canal and is considered a weak spot in the abdominal wall muscles. The actual causes of a femoral hernia are:
Unlike other types of hernia, femoral hernias usually require treatment straight away due to potential complications associated with them. Surgery can be performed to put the bulge back into place and to fix the weakened abdominal wall. Complications that can result from femoral hernias include:
Obstruction where part of the bowel can become stuck in the femoral canal resulting in nausea and pain.
Strangulation where the stuck section of bowel has its blood supply cut off (ischaemia), which required immediate surgical attention so that blood supply is restored and the tissue doesn’t die.
Surgery for treating femoral hernias can either be open surgery, or it can be performed laparoscopically. Patients can usually return home either the same day or the following day.
A fistula is when a connection forms between an organ and another structure, and usually develop when an organ becomes inflamed or injured. Fistulas are very common in people who suffer with Crohn’s disease, an inflammatory bowel disease, with around 35% of people with Crohn’s disease having at least one fistula.
Fistulas can appear in numerous places in the body, but they are most commonly found around the anus. These kind of fistulas are called perianal fistulas. Another common form of fistula is the kind that develops between loops of intestine. Fistulas can also form between the rectum and vagina, between the intestine and the skin, between the intestine and the bladder, between the trachea and the oesophagus, and in other places.
Fistulas can form in a number of different ways, depending on the type of fistula and the position. With anal fistulas, they most commonly form because of an anal abscess. If the abscess hasn’t healed properly, it can lead to the development of a fistula. It is estimated that up to 50% of people with an anal abscess can then go on to develop a fistula.
Fistulas that form in the digestive tract can do so following surgery, radiation therapy for cancer, or due to a traumatic injury. Some diseases can also cause fistulas such as STIs and diverticulosis.
Some fistulas such as tracheoesophageal fistula (TOF) can form in the baby during pregnancy.
Fistulas can often be repaired with surgery. The appropriate medical professional will diagnose the fistula and decide on the best course of action, depending on the kind of fistula and the position.
Another way of treating a fistula is with a catheter used to drain the fistula. These are usually used on small fistulas to control infection.
Fistulas may also be repaired with a kind of glue called fibrin glue, which can be adopted to seal the fistula where appropriate. A plug can also be used to fill a fistula.
The symptoms of a fistula may be managed with medication in some cases, and to treat infection caused by a fistula.
Treatment for most kinds of fistula is fairly successful.
Genital warts (also known as condyloma) are a common type of sexually transmitted infection (STI), manifesting as small growths or lumps, usually pink in colour, around the genitals. They frequently occur in clusters, although sometimes there may be only a single wart. Spread by skin-to-skin contact during vaginal, anal or (occasionally) oral sex, genital warts are the most obvious symptom of infection by the human papilloma virus (HPV).
Genital warts rarely cause serious pain or discomfort themselves, but certain strains of HPV are associated with causing cancer, particularly cervical cancer, so it is important for women who have found genital warts to have regular cancer screenings.
Genital warts are themselves symptoms of HPV. They affect the moist tissue of the genitals and can vary in appearance. They may appear as small, flesh-coloured bumps or pale, cauliflower-like structures. They can be either hard or soft, and although they are usually painless some may cause irritation or even bleed.
They can appear anywhere on the genital or anal area, including the tip and shaft of the penis and the scrotum in men; the vulva, the walls of the vagina, and the cervix in women; and around the anus in both sexes. Sometimes, infection will not be immediately obvious because the warts are too small to see, and may even be inside the vagina, the opening of the urethra or the anus.
If you experience the following symptoms, you should get yourself checked out by a doctor:
If your sexual partner is showing any of these symptoms, it is also worth visiting a doctor in case you have been infected.
Genital warts are caused by the human papilloma virus (HPV). There are more than 40 strains of HPV that can affect the genital area, which can be spread through skin-on-skin sexual contact, although in most cases, the immune system kills the virus before you develop symptoms of the infection.
The virus can be passed from person to person regardless of whether or not there are visible warts.
Genital warts can be passed on by:
Genital warts can’t be passed on by:
The best way to prevent the spread of HPV and avoid genital warts is to practice safe sex, using latex condoms, as well as avoiding sexual contact with infected people. However, even using condoms is not a guarantee that there will be no contact with infected skin, because warts can appear in unprotected areas around the genitals such as the scrotum.
There is also a vaccine that protects against some strains of HPV that cause genital warts and the strains that are associated with cervical cancer.
There are several treatments for genital warts, depending on the nature of the warts and what the doctor recommends:
In some people, treatment is ineffective, while in others the warts return while the virus is still present in the patient’s body. There is no definitive cure, but in time the immune system may clear the body of the virus by itself.
Hemorrhoid surgery (piles) is surgery that is done to treat the veins that have been swollen or expanded around the anus. Hemorrhoid surgery is indicated when the patient has itching in the anus, anal bleeding, pain or gore. Piles operation can be carried out using different techniques, the most common is the hemorrhoidectomy, which involves removing hemorrhoids and leave the area sterile gauze to slow the bleeding. Another method is stapled hemorrhoidopexy (also called PTT or Longo method) which involves inserting a mechanical seaming anal rectal excising the excess tissue and, simultaneously, the mucosa with metallic suture points and hemorrhoids are repositioned in his natural position. There is also a surgical procedure to cure hemorrhoids that does not involve the removal of tissue: dearterialization guided transanal hemorrhoidal doppler (THD method), a minimally invasive and virtually painless technique that involves locating, with a Doppler probe and suture the hemorrhoidal artery that carries blood to hemorrhoids. In the same operation, mucosal prolapse has been placed on your site.
A hernia appears as a lump, most commonly in the abdominal or groin area. They occur when an organ, often the bowel, protrudes through the cavity which normally contains it.
An incisional hernia is a type of hernia where tissue protrudes through an incision made during previous surgery that hasn’t fully healed. It can occur as a complication from abdominal surgery and is more likely to occur following emergency surgery. The herniated tissue may be part of the intestine, part of another organ in the abdomen, or other abdominal tissue.
Although hernias can appear unsightly, often they won’t produce any problems. However, if they become larger, they can become problematic, increasing the risk of complications such as strangulation to the affected tissue.
The main symptom is a lump or bulge in the abdomen close to the site of the surgical incision. Pain is also common, which is often worse while upright and relieved when lying down. Another risk of having an incisional hernia is bowel obstruction in which can result in nausea and pain.
Typical symptoms of incisional hernias include:
Incisional hernias occur following surgery. The surgical incision causes a weakness in the abdominal muscle, through which tissue can herniate if put under pressure. This pressure may be due to the patient engaging in physical activity too soon after the operation, gaining weight rapidly, or becoming pregnant.
Treatment for an incisional hernia is usually further surgery. This can be performed either as open surgery or laparoscopically. They hernia will be pushed back in and the weakened area of the abdominal wall will be strengthened, sometimes with mesh.
Inflammatory bowel disease (IBD) is used to refer to chronic diseases affecting the intestine. the most common are Crohn’s disease (CD) and ulcerative colitis (UC).
A hernia occurs when part of the internal organs or tissue pushes through a weakness in the muscle wall. An inguinal hernia is said to occur when part of the bowel or fatty tissue pushes into the groin at the top of the thigh. It is also the most common type of hernia, particularly in a male. Inguinal hernias are rare in females.
Symptoms of an inguinal hernia are a swelling or a lump in the groin or an enlarged scrotum. There may also be associated pain or discomfort, pain when coughing or lifting, or a dragging sensation in the groin. A bulge either side of the pubic bone could also be a sign of an inguinal hernia.
The hernia may be pushed back in when lying down, however complications can occur whereby the hernia gets stuck or trapped and obstructs the bowel, or the hernia becomes strangulated, whereby the blood supply gets cut off. This is potentially very serious, even life-threatening and requires immediate attention. Symptoms of a strangulated hernia include vomiting and nausea, fever, sudden pain, a bulge that turns red or purple, or an inability to pass stools or gas.
In males the testicles descend during development via a small opening in the groin. This process leads to a weakness in the abdominal wall and is the cause for inguinal hernias. In a boy there is usually a sac which accompanies the testis. Generally it is supposed to close but occasionally the sac remains, leading to a hernia.
In adults, undue straining such as heavy lifting, violent coughing or prolonged straining on the toilet may cause the hernia to develop due to the underlying weakness in the groin. Loss of elastic tissue due to the ageing process also leads to inguinal hernias. It is not unusual for hernias to occur in both groins.
Avoiding undue pressure in the abdomen by straining when passing stool or urinating or carrying and moving heavy loads can reduce the risk of an inguinal hernia, however many hernias may be unavoidable as they have no apparent cause. Strain on the abdominal muscles can be reduced by maintaining a healthy weight, eating a high-fibre diet and stopping smoking.
Surgery is the usual treatment for inguinal hernias. In some patients a non-surgical option, such as a hernia truss, may be appropriate. Occasionally it may be appropriate to wait and watch and monitor the hernia. Surgery becomes an emergency for hernias that cause severe pain or that have developed complications. Strangulation, where the bowel has become trapped, is one such complication and it requires immediate treatment to restore the blood supply via surgery.
Irritable bowel syndrome (IBS) is a functional disorder of the large intestine.
IBS is characterised by abnormal movements in the muscles of the intestine, which cause discomfort and abnormal function, as well as constipation and diarrhoea alternately. IBS can also provoke abdominal pain, gas, bloating and changes in bowel habits.
Irritable bowel syndrome is usually associated with stress-related problems, although it has been shown that stress does not provoke it, but rather increases its effects. The exact causes of IBS are not clear, although it may occur after an intestinal infection.
This condition is often confused with inflammatory bowel disease (IBD) which, unlike IBS, is caused by the abnormal structure of the colon.
IBS is different in everyone and while the condition itself cannot truly be prevented, it can be avoided after diagnosis through certain lifestyle changes and management of the symptoms. For example, if you have IBS, it is not recommended to skip meals or eat later than you usually do, in addition to not rushing meals or eating too quickly. Avoiding spicy foods or ‘trigger’ foods can also help to keep IBS at bay. Many people with IBS prefer to cook their own meals as it means they can fully control what they are eating, thus avoiding triggers.
For the diagnosis of irritable bowel syndrome, there is no specific test, but it is necessary for the doctor to rule out other conditions in which symptoms are similar. Therefore your doctor may arrange for blood tests or stool samples to be taken to make sure the right diagnosis is given.
Although there is no cure for IBS once diagnosed, as it is a chronic condition, certain measures can help to alleviate the symptoms:
Pruritis ani is the medical term for an itchy bottom or irritation of the skin around the anus (“pruritis” refers to itching sensations of the skin). An itchy bottom is a common symptom that can be caused by a number of conditions. Despite this, patients are often reluctant to see a doctor about it as they are embarrassed. It is thought to be more common in men than women.
Itching may get worse at night or after defecation. It is advisable not to scratch, as this can cause tiny breaks in the skin, which, combined with the general moisture and humidity of the anal area, cause more irritation and the itching gets worse
There are two main types of anal itching:
Some possible causes of anal itching include:
Some tips to prevent anal pruritus or stop it getting worse are:
The treatment of anal itching usually focuses on maintaining a proper routine for proper hygiene. If there is a secondary cause, the treatment will vary.
In general, the basic treatments for anal itching include:
You should see a doctor if:
Laparoscopic hernia repair is a minimally-invasive surgery performed with general anaesthesia. A laparoscope is a flexible, thin instrument with a light source and camera on the end. It is inserted through small incisions made in the abdomen, depending on where the hernia is. The surgeon is then able to use this camera to guide his surgical repair.
Laparoscopic hernia surgery is less invasive than open surgery and leaves just three small scars instead of one large one. As a result, there is less pain following surgery and a quicker recovery period. Patients are able to return to normal activities sooner than after having open hernia repair surgery.
During laparoscopic hernia surgery, the abdomen is inflated with carbon dioxide gas to allow a better view for the surgeon. The surgeon performs the repair of the hernia using stitches and synthetic mesh which provide reinforcement of the abdominal walls. Once repaired, the small incisions are closed with stitches or surgical tape. These stitches will dissolve over time and do not require later removal.
Before laparoscopic hernia surgery is recommended by your specialist, you will have had a thorough physical examination, an MRI scan and an ECG to assess your cardiac health. You will also be given general anaesthesia for this surgery and you won’t feel anything during the procedure. As such, food, drink and certain medications will have to be stopped for a certain period before the operation.
After laparoscopic hernia surgery, patients can normally return home the same day, providing they are not experiencing a lot of pain, nausea or vomiting. You can expect to be a bit sore for the first couple of days after surgery, but this can be managed with rest and painkillers. You should be able to walk around after surgery, working up to more strenuous activity slowly over the following two weeks. It is important to eat high-fibre foods during recovery to avoid constipation and straining on the toilet.
Hernias may also be repaired using open surgery or robotic repair surgery. Open surgery involves a larger incision being made to access the site of the hernia. The hernia is then pushed back into the correct position, reinforced with either stitches or synthetic mesh. Robotic repair is also performed laparoscopically, but the surgeons sits at a special console where they control the movements of the surgical instruments from this console.
Laparoscopy is a minimally invasive surgical technique which allows the surgeon to operate without the need for deep or large incisions in the skin. This means the recovery period is generally shorter, there is less pain after the operation, and scarring is reduced significantly for the patient. This technique is also known as keyhole surgery.
Laparoscopy can be used to both treat and diagnose a range of conditions across specialties such as surgery, gynaecology, gastroenterology, and urology. Laparoscopy may be used in investigation, to check symptoms and attempt to reach a diagnosis, for example in cases of ovarian cysts, fibroids, pelvic inflammatory disease, and appendicitis. Laparoscopy can also be used to take a biopsy (a small sample of tissue) meaning it can be used to investigate certain cancers, e.g liver cancer, ovarian cancer, pancreatic cancer, and many more.
As a surgical technique, laparoscopy is especially useful as it allows for minimal scarring and a shorter recovery period, which is advantageous to the patient. Laparoscopy can be used as a surgical technique in many situations, such as:
Laparoscopy is performed under general anaesthetic. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them. The surgeon uses small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on.
Generally, you will be asked not to eat or drink anything for 6-12 hours before the procedure. You will also be asked to stop taking blood-thinning medication a few days before the procedure takes place. If you are a smoker, your surgeon may advise you not to smoke for a few days before the procedure, as smoking can delay the healing process.
As laparoscopy is a minimally invasive procedure, you can generally go home either on the same day or the day following surgery. Someone will need to accompany you home as you will be advised not to drive for the 24 hours following the procedure.
Recovery from laparoscopy depends on the type of procedure performed. After diagnostic laparoscopy, for example, you may be able to resume normal activity after five days. If surgery is more minor, for example ulcer repair, normal activity may be resumed in around three weeks. Major surgery, such as hysterectomy or organ removal (e.g kidney) typically takes longer – up to 12 weeks. Your surgeon or doctor will advise you on how to clean your stitches and keep wounds clean.
Expect to feel tired or somewhat drained after surgery for a few days, but this should pass as your body uses less and less energy as the recovery process goes on. If you experience any pain, you can take over-the-counter medication pain relief to reduce it.
Laparoscopy is a minimally invasive technique which is used as an alternative to traditional open surgery. Open surgery may be necessary in certain situations and your surgeon will speak to you regarding your options before making a decision as to which type of surgery will be performed.
A lipoma is a benign lump that forms under the skin, usually made from fatty tissue. They usually grow slowly and are situated between the skin layer, and the muscle layer beneath.
Lipomas are more common in middle age, are usually painless, and most commonly appear on the upper back, shoulders and abdomen.
The cause of lipomas is unknown. It is believed that they may be genetic, so if your parents or other members of the family had lipomas, then you may also be prone to developing them. They can often appear after an injury, though the reason they form is unknown.
As previously mentioned, lipomas are usually painless, though can cause some pain if they press on nearby nerves. They appear as soft, doughy lumps ranging in size from around the size of a pea to as big as a grapefruit. The lumps may move slightly if pressed.
Although people of any age can develop lipomas, they are more prevalent in adults aged between 40 and 60 years of age.
People with the following conditions are more at risk of developing one or more lipomas:
Lipomas don’t usually cause any problems if left alone, however they can be treated if required.
The most common way of treating lipomas is to have them surgically removed. This can be done by either a dermatologist, or by a plastic surgeon.
Surgery involves making an incision to remove the fatty tissue, before suturing the opening. Though there is a risk that the lipoma may return, it is uncommon.
Another treatment option to reduce the size of the lipoma is liposuction, where a needle is used to remove some of the fat from within the lipoma.
Finally, steroid injections may be used to treat the lipoma. The steroid injection works to shrink the lipoma, though this treatment doesn’t completely remove the lipoma.
Lumpectomy is a surgical procedure carried out with general anaesthetic that removes cancer and abnormal tissue from the breasts. It is also known as breast-conserving surgery because compared to a mastectomy only a section of the breast is removed.
The aim of a lumpectomy is to remove the cancerous tissue whilst conserving the appearance of the breast. Recent studies have indicated that lumpectomy is as effective at preventing cancer returning as a double mastectomy.
A specialist might recommend a lumpectomy if the cancer found through biopsy is in its early stages and small, as well as being in a suitbale position and only in one area of the breast. Often lumpectomy will be complemented by radiotherapy as well which aims to destroy any remaining cancer cells still in the breast following surgery.
A lumpectomy is performed using general anaesthesia, meaning you are unaware during the surgery. Firstly the area for excision is located, using a mammogram and biopsy. Once located, the radiologist will place a thin wire or radioactive marker into the section of cancerous breast tissue. This wire placement guides the surgeon in surgery.
During lumpectomy, the lymph nodes are also often removed. This allows the specialist to determine if the cancer has spread beyond the breast tissue. This will either be done through an axillary node dissection or a sentinel lymph node biopsy. Once tested, if no further cancer is found then no more lymph nodes need to be removed. If there is more cancer, then either further surgery or radiation treatment will be needed.
In surgery, the surgeon makes an incision where the wire is and removes the cancer and surrounding tissue. The incision is closed using stitches, taking care to preserve the appearance of the breast.
Before surgery, you will have met with your surgeon and discussed how the surgery is performed, as well as expectations for healing and scarring. When you meet your surgeon it is important to have a list of questions you may have so that you understand the procedure and any risks it may carry.
A lumpectomy can often be carried out as a day-case procedure so a hospital stay is not always required. Prior to surgery certain medications will have to be stopped, and 8-12 hours before surgery you will have to stop drinking and eating.
Following surgery, you will be released from hospital once you are stable and the anaesthesia has mostly worn off. It is important to have someone take you home from the hospital. You can expect the following:
Getting the results from the lymph nodes will take a week or so and will be discussed in the follow-up appointment with your doctor. Potential further treatment will be discussed in this appointment.
The wound generally takes 2-3 weeks to heal, and it will be bruised and swollen initially. You will be told how to look after the wound at home. It is important to avoid heavy lifting, driving and exercise until your wound has healed.
Your breast cancer treatment will depend on where the cancer is located, the size of the cancer, the size of your breasts and your own wishes. Sometimes it is necessary to have a mastectomy (surgery that removes the whole breast). Discussing your options with a specialist will be essential in making your treatment decision.
Lymph nodes, also known as lymph glands, are small glands found throughout the body and form a part of the lymph system. The lymph system is a network of organs and vessels the carries a fluid around the body between tissue and the blood. The fluid contains white blood cells called lymphocytes.
The lymph system plays an integral part of the immune system, fighting against disease and infections.
Lymph nodes can be found on their own, or in groups. You can feel groups of lymph nodes in the neck, groin and underarms. You generally cannot feel most lymph nodes in the body, however, if they are swollen in the neck, you are able to feel them.
Lymph nodes help to fight disease and they do so by filtering the lymph fluid and trapping any bacteria or viruses that pass through them. They are then destroyed by the lymphocytes, in an effort to destroy such substances before they infect other parts of the body. When lymph nodes are swollen, it usually means that they are exposed to bacteria and viruses and fighting an infection.
It means that they are likely fighting an infection. However, more rarely, swollen lymph nodes could be caused by an underlying condition such as cancer. Swollen lymph nodes can feel tender or painful.
Depending on which lymph nodes are swollen, it can help determine what the problem might be.
Neck:
Armpit:
Groin:
Collarbone:
If you are concerned at all, then you should see a doctor, however, it is recommended that you see a doctor if:
Minimal access surgery (MAS) is a surgical approach that can be used within many areas of gynaecology, including reproductive medicine, urogynaecology, gynaecological oncology and benign gynaecological surgeries. MAS does not involve open surgical techniques, which with them require longer recoveries and chances of complication. MAS techniques used keyhole surgical methods such as laparoscopy and hysteroscopies. Often MAS can be carried out as a same-day or outpatient clinic procedure.
The following conditions might require MAS:
Diagnostic hysteroscopy –
Operative hysteroscopy –
Complex operative laparoscopy can be used to treat –
Hysteroscopy:
Laparoscopy:
Hysteroscopies are a day-case procedure and no stay at the hospital will be required. Before the hysteroscopy you will be tested to check for suitability (you cannot have a hysteroscopy if you are pregnant), you will be advised to stop smoking if you are going to have general anaesthetic. If you are having fibroids removed, then you might be prescribed medicine to reduce their size first.
As laparoscopies are carried out under general anaesthetic, you won’t be able to drink or eat up to 12 hours prior to surgery. You may need to stop taking certain medications and to stop smoking.
After a hysteroscopy, you can normally return home the same day, or at least until the anaesthesia has worn off. It is normal to feel cramps that are similar to menstrual cramps for a few days, and you might also experience some light bleeding. Most women feel they can return to work after a day or two.
Recovery from a laparoscopy varies and depends on why the laparoscopy was carried out. If the procedure was diagnostic, you can usually return to normal activities within a few days. If you had treatment during the laparoscopy, then recovery is likely to take up to 12 weeks.
Haemorrhoids, commonly known as piles, are swollen veins in the anus or lower part of the rectum. They are a very common ailment. Haemorrhoids may be either internal or external. External haemorrhoids generate protuberances in the ring of the anus on the outer side, making them easier to diagnose and can cause pain when sitting, in addition to traces of blood when defecating. On the other hand, internal haemorrhoids occur inside the anus causing bleeding in the stool and itching in the anal region.
The main symptoms of haemorrhoids are:
Haemorrhoids occur due to increased pressure in the anus. They can be caused by:
To prevent haemorrhoids, it is necessary to avoid constipation. For this reason, it is important:
In the case of external haemorrhoids, the treatment consists of applying creams and warm water in the affected area. In cases of severe pain, you can take painkillers. As for internal haemorrhoids, surgical intervention may be necessary to remove them.
A pilonidal sinus is a small tunnel in the skin which can fill with pus or fluid, resulting in either a cyst or abscess. These usually occur in the top of the buttocks where they divide. They do not always produce symptoms, however, if it becomes infected it requires attention. If you are aware of a pilonidal sinus, but it is not infected, it is important to take a ‘watch and wait’ approach.
If the pilonidal sinus becomes infected, then a cyst or abscess can form which can cause pain and discomfort, particularly when sitting down. Hence, infected pilonidal sinuses are common in people who sit down a lot, such as lorry or taxi drivers.
Signs of an infected pilonidal sinus are:
The cause of a pilonidal sinus is still unknown, however, it is thought to be caused by a combination of the following:
It can help to keep the area very clean, and to avoid sitting for long periods of time.
If the infected pilonidal sinus is not too painful or advanced, then antibiotics will be prescribed to fight the infection. However, this treatment does not fully heal the sinus, so after the infection is gone, it is important to keep the area clean and hair-free with frequent shaving.
If the infection is particularly bad, the abscess might be lanced to drain the pus, hair and blood from the sinus. Once it is healed, it is important to pay attention to the site and keep it clean. Depending on the size of the abscess, this procedure will be done either under local or general anaesthetic.
Surgery can also be carried out to remove the sinus altogether. The wound will either be left to heal openly, or it will be flattened and closed with stitches. Both have their advantages and disadvantages. Open healing has a lower risk of the sinus returning, however, recovery time is up to 12 weeks. Closed healing has a quicker recovery time, but the chances of infection returning are higher.
Polyps are abnormal tissue growths. They can form in different parts of the body:
Polyps are a common problem and most of them are benign, although some types have been linked to cancer.
A rectal prolapse is when part of the rectum protrudes through the anus. The rectum is at the end of the large bowel and is where the faeces collect before passing through the anus as a bowel movement. The rectal is made up of three layers, the rectal wall lining (mucosa), a layer of muscle (muscularis propria) and a fatty tissue that surrounds the rectum (mesorectum). If the wall of the rectum sticks out through the anus, it is a rectal prolapse.
The three types of rectal prolapse are:
A lump or swelling coming out of the anus may be noticeable when having a bowel movement. If the prolapse gets worse, it could also protrude when coughing, sneezing or standing up. If the prolapse is an internal rectal prolapse, it may not feel like the bowels are fully emptying. Other symptoms of a rectal prolapse include:
A rectal prolapse is often associated with weak muscles in the pelvis. These are triggered by pregnancy, constipation, diarrhoea and a lot of coughing due to conditions such as cystic fibrosis or whooping cough. As women age, a rectal prolapse can happen at the same time as a prolapsed uterus or bladder. The pelvic floor muscles weaken over time or weaken after having given birth.
A rectal prolapse is diagnosed following a rectal examination. Further tests may be needed, which may include a proctography, colonoscopy or endoanal ultrasound.
In children, rectal prolapse usually gets better without any treatment. Adults are recommended to treat constipation by eating high-fibre foods or taking laxatives. Surgery may be offered with the type of surgery depending on the type of prolapse, the patient’s age and a history of medical problems. There are two types of surgery.
Rectal surgery covers a large number of procedures used to treat conditions that affect the rectal area and colon. The disorders that rectal surgery addresses include:
Procedures that are a type of rectal surgery include:
Surgery might be recommended for any of the above conditions if other means of treatment have failed, or if the condition is severe enough to require surgical intervention.
Colectomy:
Colostomy:
Endoscopy:
Colonoscopy:
Haemorrhoidectomy:
IBD surgery:
Resection:
Internal sphincterotomy:
Rectopexy:
Depending on which type of procedure and disorder you have, preparation for surgery will differ. For more intensive surgery, health will need to be monitored and improved before surgery, and often a period of fasting the day before surgery will be required.
Recovery from rectal surgery differs depending on the type. Those carried out laparoscopically (keyhole surgery) will often allow same or next day discharge from hospital. Other, more intense surgeries may require a stay in hospital for up to two weeks.
What is rectocele?
Rectocele, also known as posterior vaginal prolapse, is a condition in which the tissue wall between the rectum and vagina weakens. This allows the vaginal wall to bulge. Childbirth and processes that put pressure on pelvic tissues can lead to rectocele. Self-care measures are often very effective but severe rectocele may require surgical repair.
What are the symptoms of rectocele?
A woman may notice pressure within the vagina, or that her bowels do not feel empty after having used the bathroom. In moderate cases, when trying to push the stool out through the anus may push it into the rectocele instead. This can cause pain and discomfort and creates a higher chance of having constipation. It could also lead to pain during sexual intercourse. More severe cases include vaginal bleeding and sometimes the rectocele bulge may prolapse through the vagina mouth or through the anus. Most of the time, many women have a rectocele but do not notice all of the symptoms.
What causes rectocele?
The commonest cause of rectocele is childbirth, especially if the baby is heavy, or if the birth happens quickly. The muscles, ligaments and tissues in the vagina become stretched and weakened during pregnancy, labour and delivery. If a woman has had more than one vaginal birth she is at a higher risk of developing rectocele. Women who have never given birth can also develop a posterior vaginal prolapse. Rectocele occurs as a result from pressure on the pelvic floor. Increased pelvic floor pressure can be caused by constipation or straining with bowel movements, chronic coughing, repeated heavy lifting or obesity.
What are the risk factors of rectocele?
The following factors may increase the risk of rectocele:
How can you prevent rectocele?
To reduce the risk of worsening rectocele, a woman can:
When should you see a doctor?
Rectocele is a common condition in both women who have had children and those who have not. It is recommended to see a specialist if suffering from chronic constipation and if there is a bulge of tissue that protrudes through the vaginal opening.
Robotic head and neck surgery is one of the latest technological advances in surgery. This novel technology helps overcome restrictions present with conventional surgical techniques. Surgery is not performed by a robot but by the surgeon using robotic technology. Robotic surgery permits access to small spaces and removes all natural hand tremor. It permits precision surgery in real time using a 3D visual field.
Robotic-assisted surgery, or robotic surgery, with the da Vinci System allows doctors to perform surgical procedures in a very accurate way. Operations are performed with more precision, flexibility and control compared to using conventional techniques. Robotic-assisted surgery is commonly associated with minimally invasive surgery, where procedures are performed using tiny incisions.
Robotic-assisted surgery with the da Vinci Surgical System uses a camera arm and mechanical arms with surgical instruments attached to them. The surgeon is able to control the arms whilst seated at a computer console near the operating table. The surgeon has a high-definition 3D view of the surgical site and leads other team members who assist them during the surgery. The surgeon makes small cuts to insert the instruments in the patient’s body. A thin tube with a camera attached to the end of it, as with an endoscopy, enables the surgeon to view enlarged 3D images of the patient’s body during the surgery. The robot corresponds and matches the hand movements of the doctor to perform the procedure using tiny instruments.
Surgeons who use the robotic system find that for many procedures it enhances control during the operation and allows them to see the site more clearly. The benefits of minimally invasive surgery using the da Vinci Surgical System include:
Robotic-assisted surgery has small risk factors, which may be similar to those of conventional open surgery. The risks could include:
The ideal patient for the robotic-assisted procedure is someone who has not had many abdominal surgeries. Typical abdominal surgeries such as an appendectomy, gallbladder removal and hernia repair do not exclude individuals from having robotic surgery. The decision will be made by the surgeon. Patients with prevalent cardiovascular and pulmonary diseases may require more consideration beforehand.
Traditional open surgery recovery time can last several months, including several days of hospitalisation. Even though every case of surgery is unique, the return to everyday activities for a patient following robotic-assisted surgery can occur in as little as two to three weeks.
Ulcerative colitis is a condition where the large intestine and rectum become inflamed and eventually produce ulcers. It is a type of inflammatory bowel disease, along with Crohn’s disease. Inflammatory bowel disease affects more than 620,000 people in the UK .
Ulcerative colitis is a long-term condition, which means it can’t be cured. Instead, treatment focusses on managing the symptoms, and achieving “remission”, where no symptoms occur.
This doesn’t mean that symptoms can’t come back – ulcerative colitis is a fluctuating condition involving “flare-ups” (see below).
The main symptoms of ulcerative colitis include:
Ulcerative colitis is characterised by “flare-ups”, where symptoms worsen for a period of time, and you can experience symptoms in other parts of the body. These can include:
Everyone experiences ulcerative colitis differently. With the right treatment and self-management, some people can experience long periods of “remission” where you only experience mild symptoms, or even none at all.
Diagnosis will usually involve a combination of:
Sometimes the doctor might need to do an X-ray to check if there are serious complications, but this is much less common.
It’s not clear exactly what causes ulcerative colitis. Many health professionals now think that it could be an autoimmune condition, involving the immune system mistakenly attacking healthy cells. This may be triggered by an infection in the large intestine.
However, other factors appear to play a role:
Ulcerative colitis therefore seems to be caused by a combination of genetic and environmental factors.
Treatment for ulcerative colitis includes lifestyle and diet changes, medication, and in very rare cases, surgery.
For some people, making changes to their diet can help control the symptoms and reduce the frequency of “flare-ups”. Some helpful changes can include:
Your doctor may prescribe a combination of drugs to achieve different goals, including:
Surgery is generally only recommended when a patient hasn’t responded to medication, or are experiencing severe flare-ups that significantly affect their day to day life.
Surgery will involve removing the colon, and replacing its function with an ileostomoy or ileo-anal pouch. This results in a complete cure of the condition.
An umbilical hernia is a type of hernia, which refers to when part of the internal organs protrude through a weakness in the surrounding cavity.
In the case of an umbilical hernia, abdominal fat or part of the bowel passes through an area around the navel.
Umbilical hernias are very common, particularly in babies and are characterised by a bulge around the navel that might get bigger when laughing or coughing. They are usually painless in infants and children, however, in adults who develop an umbilical hernia, the swelling may also be accompanied by pain and discomfort.
An umbilical hernia develops as a result of a weakness in the abdominal wall at the navel. If the hole through which the umbilical cord passes through during pregnancy doesn’t close properly after birth, it can cause a hernia either at birth or later on in life. In adults, too much pressure in the abdominal cavity can increase the possibility of an umbilical hernia.
There is little that can be done to prevent umbilical hernias at birth, however, there are certain risk factors for adults. Anything that increases pressure in the abdominal cavity, such as obesity, straining while moving or lifting heavy objects, a persistent heavy cough, ascites (fluid in the abdomen, and having multiple pregnancies (i.e. twins, triplets, etc.), can increase the risk of an umbilical hernia.
In infants, an umbilical hernia very often clears up on its own – the hernia goes back in and the muscle reseals over it. In adults, an umbilical hernia will generally get worse over time.
In most cases, it is advised to wait until a child has reached four of five years of age to see if the hernia disappears before considering surgery, except in cases where the hernia is very large or there are other complications.
In most adults, umbilical hernias are treated with surgery to push the abdominal tissue back into place and seal the abdominal wall. Complications can include obstruction where a section of bowel gets stuck outside the abdomen and can cause nausea, vomiting and pain and discomfort. Strangulation, whereby the blood supply to the section of bowel forming the hernia is cut off, is a potentially serious complication and needs emergency treatment to prevent the trapped tissue from dying.
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Haemorrhoids (piles) and rectal prolapse are two conditions with very similar symptoms, but key differences regarding their treatment. Mr Charles Evans, a leading consultant general surgeon, has treated these conditions many times and in this article, he provides you with the knowledge to decipher the difference.
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Sometimes people experience worrying changes in their bowels, like a change in bowel movements, diarrhoea or even blood in their stools. They may also feel that they have a huge mass within their tummy and experience unusual cramps and pains. All of these symptoms will require further investigating. Mr Charles Evans, colorectal cancer specialist talks to us about detecting colorectal cancer and the use of robotics in colorectal surgery.
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