Conditions & Treatment

  • This cancer starts within the lining of the large bowel (colon) or the last part of large bowel before reaching the back passage (rectum).
    Symptoms to look out for include:
    Persistent change in normal bowel habit for more than 2-3 weeks such as looser motions, passing more frequent motions, or getting constipation
    Bleeding from the back passage, or blood that is mixed with stool
    Pain or lump in your tummy
    Unexplained weight loss, and / or loss of appetite
    Tiredness caused by lower than normal level of red blood cells (anaemia)Treatment depends on which part of the colon the cancer starts.
    Right colon cancer: Surgery includes removal of the right colon and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with low chances to have a stoma (Right Hemicolectomy)
    Transverse colon cancer: Surgery includes removal of the right colon, transverse colon and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with low chances to have a stoma (Extended Right Hemicolectomy)
    Left colon cancer: Surgery includes removal of the left colon and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with low chances to have a stoma (Left Hemicolectomy)
    Sigmoid / upper rectal cancer: Surgery includes removal of part of the left colon, upper part of the rectum and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with a possibility to have a stoma (High Anterior Resection)
    Mid rectal cancer: Surgery includes removal of lower part of the left colon, the whole rectum and associated blood vessels and lymph glands. The bowel ends are then joined (anastomosis) with most likely creating a diverting temporary stoma that can be reversed by another smaller surgery (Low Anterior Resection)
    Low rectal cancer: Surgery includes removal of the whole rectum, anus and all associated muscle, and associated blood vessels and lymph glands resulting in permanent stoma (Abdominoperineal Excision of the Anus and Rectum - APER)

  • This rare cancer starts in the lining of the back passage (anus). Symptoms include bleeding, bowel changes, pain around the back passage, and severe itching (pruritis). These symptoms could be caused by other conditions, therefore it’s important to seek medical advice if you have any of these symptoms. Examination by specialist is essential to decide if further diagnostic tests are required. This includes Examination Under Anaesthesia (EUA) of the back passage and taking samples (biopsies). The mainstay of treatment of anal cancer is combined chemotherapy and radiotherapy (chemoradiotherapy). Surgery might be required for very early stages of anal cancer, or if the cancer comes back or hasn’t gone completely after chemoradiotherapy.

  • This cancer starts in the small bowel which makes up most of the digestive system and helps the body to digest food and take in vitamins.
    The symptoms of small bowel cancer can be vague and other conditions could have similar symptoms like irritable bowel syndrome or inflammatory bowel disease. Symptoms include tummy pain or lump, weight loss, feeling or becoming sick, diarrhoea, tiredness, dark black stool due to bleeding in the small bowel, blockage in the bowel, and a low number of red blood cells (anaemia) due to bleeding. It’s important to see your doctor if you have any of these symptoms to arrange for the required tests.
    Treatment will depend on many factors that include where the cancer is, how big it is and whether it has spread (the stage), type of cancer, general health and level of fitness. Treatment includes surgery to remove the cancer along with clear border if the cancer hasn’t spread to other parts of the body, or in emergency situations where the cancer has blocked the bowel. Treatment also includes chemotherapy either after surgery to reduce the risk of cancer coming back, or to reduce or control symptoms in advanced cancer that has spread to other parts of the body.

  • These are small growth on the inner lining of the colon or rectum. They are common affecting around 1 in 4 people at some point in their lives. They don’t normally have any symptoms; however, some people might get symptoms like blood in the stool or have positive Faecal immunohistochemical testing (FIT test) that detects small amount of blood in faeces (stool), which would not normally be visible. Although bowel polyps are not normally cancerous, they will need to be removed if found, as if left untreated some may eventually turn into cancer.
    Polyps can be of various types;
    Hyperplastic polyps are usually small and generally regarded as harmless.
    Adenomas are a common type of polyps. There is a small risk that that adenoma may, in time, be cancerous. This change usually takes place after number of years.
    Polyposis syndromes: They are group of rare inherited conditions that cause multiple bowel polyps in young people that have a high chance of developing into bowel cancer. This includes Familial adenomatous polyposis (FAP), Hereditary nonpolyposis colorectal cancer (HNPCC)/Lynch's syndrome, Gardner's syndrome, Turcot's syndrome, Peutz-Jeghers syndrome, Cowden's disease, and Familial juvenile polyposis.

  • This term means there are abnormal cells in the lining of the back passage (anus). It is also called anal squamous intraepithelial lesions (SILs). AIN is not cancer but the cells might develop into cancer in the future. This is diagnosed by taking a sample of skin (biopsy) to be examined under a microscope. It is divided into grades 1 to 3. The grade relates to how abnormal these cells look under a microscope.
    AIN 1 – the cells are slightly abnormal
    AIN 2 – the cells are moderately abnormal
    AIN 3 – the cells are severely abnormalAnother system for grading refers to AIN or SIL as low grade or high grade. In low grade SIL (LSIL or AIN 1) the cells are slightly different to normal anal cells. In high grade SIL (HSIL or AIN 2 to 3) the cells are moderately to severely different from normal anal cells.Low grade SIL (AIN 1) doesn’t usually require treatment. Repeating the skin samples might be required to confirm a diagnosis. Treatment of High grade SIL (AIN 2 to 3) might include surgical excision for localised disease or skin creams such as imiquimod or 5 Fluorouracil (5-FU), if the disease is affecting multiple parts. Clinical review in clinic and arranging mapping biopsies under general anaesthesia every 6 months are key to ensure resolution and no progression to anal cancer.

  • It is a test to check inside your throat, food pipe (oesophagus) and stomach, known as the upper part of the digestive system. A long, thin, flexible tube with a small camera inside it, is passed into the mouth then down the throat and into stomach. A gastroscopy can also be
    used to remove tissue for testing (biopsy) and treat some conditions such as stomach ulcers. You will usually be offered medicine called sedation to make you feel relaxed and sleepy, and throat spray to numb your throat.

  • It is a test to check inside your large bowel. A long, thin, flexible tube with a small camera inside it, is passed into the back passage through all parts of large bowel up to caecum
    to assess for any causes of your bowel symptoms. A colonoscopy can also be used to take biopsies or remove polyps. Two days before colonoscopy you will have to follow special diet and you will be given a laxative so your bowels are empty for the test. This needs to be followed as it says on the letter otherwise the specialist may not be able to do the test. During colonoscopy, you are usually awake but you will be offered medicines to make you more comfortable and make the test easier such as painkillers, sedation, or gas and air. It should take 30 to 45 minutes to have your colonoscopy. You might feel bloated or have stomach cramps for 2 to 3 hours after colonoscopy. You cannot drive for 24 hours if you have sedation, and someone will need to pick you up from hospital.

  • It is a test to check inside the left side of the large bowel only. It is indicated when your symptoms are suggesting that the cause is most likely from the left side of the colon. It takes shorter time compared to colonoscopy but will mostly require same preparation.

  • Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In
    most cases, they do not cause any symptoms and do not need to be treated. However, treatment is recommended if you start developing symptoms or if they cause complications.
    The typical pain caused by gallstones is called biliary colic, which is intense pain mainly in the
    upper part of the right side of the abdomen, that can be radiating to the back or to right shoulder.
    This usually last for few hours and improve with taking strong pain killers. Some patients with gallstones can also develop complications such as cholecystitis (inflammation of gallbladder), pancreatitis (inflammation of pancreas), and blockage of the main bile duct with stones resulting in jaundice (yellowing of the skin and sclera).
    Treatment of gallstones is by removing the gallbladder. This is most commonly done as
    keyhole surgery known as a laparoscopic cholecystectomy. You can lead a normal life without a gallbladder. Your liver will still produce bile to digest food, but the bile will drip continuously into the small intestine, rather than build up in the gallbladder.
    Laparoscopic cholecystectomy is one of the commonest procedures performed in surgery
    and is generally safe. Your surgeon will discuss all the possible risks of the procedure with you and will arrange any necessary preoperative investigations.

  • It is a bulge or a protrusion of an internal organ through the structure or the muscle that usually contains it. There are several types of hernia:
    - Inguinal hernia: This is the most common type of hernia and occur when fatty tissue
    or part of your bowel pokes through into your groin at the top of your inner thigh.

    - Femoral hernia: They are less common than inguinal hernias and tend to affect more women than men. They also occur at the groin at the top of your inner thigh.
    - Umbilical hernia: Occur when fatty tissue or part of your bowel pokes through your tummy near your belly button
    - Epigastric hernia: where fatty tissue pokes through your tummy, between your belly button and the lower part of your breastbone
    - Spigelian hernia: where part of your bowel pokes through your tummy at the side of your abdominal muscle, usually below your belly button
    - Incisional hernia: where tissue pokes through a surgical wound in your tummy that has not fully healed
    - Parastomal hernia: where part of your bowel pokes through your tummy at site of a stoma
    Hernias can be repaired using surgery to push the bulge back into place and strengthen the
    weakness in the abdominal wall. The operation is usually recommended if you have a hernia that causes severe or persistent symptoms, or if any serious complications develop such as obstruction (where bowel becomes stuck) or strangulation (where bowel loses its blood supply). There are 2 ways a hernia repair can be performed: Open surgery where one cut is made, or Laparoscopic (keyhole) surgery where several smaller cuts are made. The type of surgery depends on the location and size of hernia and your general fitness for surgery. Most hernias require repair with mesh to strengthen the abdominal wall, unless the defect is very small where repair can be made with sutures only.
    You should be able to go home the same day or the day after surgery. It's important to follow the instructions you're given while in hospital about how to look after yourself. This includes eating a good diet to avoid constipation, caring for the wound, and avoiding strenuous activities. Most people make a full recovery from inguinal hernia repair within 6 weeks, with many being able to return to work and light activities within 2 weeks.

  • It is a small hole or tunnel in the skin at the top of the buttocks, where they divide (the cleft). It does not always cause symptoms and only needs to be treated if it becomes infected. Symptoms can be acute if it gets infected and if pus starts to collect under the skin forming an abscess. This usually requires urgent operation called incision and drainage, where the abscess cavity is incised and left open to heal gradually with time. Alternatively, you might develop less intense symptoms such as mild pain, a lump, or discharge.
    There are numbers of treatment options for symptomatic pilonidal sinus. Examples of these options include excision and laying open, excision and primary closure, advancement flaps like Karydakis flap, or rotational flab such as Limberg flap. Other minimally invasive techniques include injection of fibrin glue and endoscopic sinus treatment. If surgery is required, these options will be discussed with you carefully and choose the most suitable for your case.

  • Diverticula are small bulges or pockets that can develop in the lining of the intestine as you get older. Most people with diverticula do not get any symptoms and only know they have them after having a scan for another reason. When there are no symptoms, it is called diverticulosis. When diverticula cause symptoms, such as pain in the lower tummy, or blood in stool, it's called diverticular disease. If the diverticula become inflamed or infected, causing more severe symptoms, it's called diverticulitis. You're more likely to get
    diverticular disease and diverticulitis if you do not get enough fibre in your diet.

    Treatment for diverticular disease include high fibre diet and increased oral fluid intake. If you have diverticulitis you might need a course of antibiotics and pain killers. While you're recovering from diverticulitis, you should eat a very low-fibre diet to rest your digestive system Surgery might be needed to treat serious complications of diverticulitis such as perforation, fistula and peritonitis (spreading infection inside the abdominal cavity). It usually involves removing the affected section of your large intestine (colectomy). After a colectomy, you may have a temporary or permanent colostomy, where one end of your bowel is diverted through an opening in your tummy.
    If you have recurrent episodes of diverticulitis, surgery can be considered to avoid developing
    further complications. If surgery is being considered, benefits and risks will be discussed very
    carefully with you.

  • Lumps can appear anywhere on your body. Most lumps are harmless but it's
    important to see a doctor if you're worried or the lump is still there after 2 weeks.
    Examples of these lumps are
    - lipoma (soft, fatty lump that grow under your skin)
    - sebaceous cyst (fluid-filled or sebum-filled lump underneath the skin)
    - ganglion cyst (fluid-filled swelling that develops near a joint or tendon)
    - dermatofibroma (harmless round, red-brownish skin growths that are most commonly found on the arms and legs),
    - folliculitis (lump due to inflammation of hair follicle)
    - boils (pus-filled lesions that are painful and usually firm, happen when infection around the hair follicles spreads deeper)
    - Carbuncles (clusters of boils)
    Treatment depends on the type and site of the lump. Excision under local or general
    anaesthesia is common if lump is symptomatic or for cosmetic reasons.

  • It is a common condition that affects the digestive system. It causes symptoms like stomach cramps, bloating, diarrhoea and constipation. These tend to come and go over time, and can last for days, weeks or months at a time. There's no test for IBS, but you might need some tests to rule out other possible causes of your symptoms such as coeliac disease and inflammatory bowel disease (IBD).
    It's usually a lifelong problem and there's no specific treatment to cure, but diet changes and medicines can often help control the symptoms. You can keep a diary of what you eat and any symptoms you get, and try to avoid things that trigger your IBS. Finding ways to relax and performing regular exercises are good ways to improve your symptoms. Probiotics which are thought to help restore the natural balance of bacteria in your gut, can be tried for a month to see if they help.
    The exact cause of IBS is unknown. it's been linked to things like food passing through your gut too quickly or too slowly, oversensitive nerves in your gut, stress and a family history of IBS.

  • It is a break in the inner lining of the stomach, first part of the small intestine or sometimes the lower oesophagus. An ulcer in the stomach is called a gastric ulcer, while that in the first part of the intestines is a duodenal ulcer.

    Symptoms include: Burning stomach pain, vomiting or vomiting blood — which may appear red or black, dark blood in stool, or stools that are black or tarry, feeling of fullness, bloating or belching, heartburn, nausea or vomiting. The main causes of peptic ulcers are infection called helicobacter pylori and taking medicines such as ibuprofen and aspirin, which irritate the lining of your digestive tract.
    It’s really important to get the right treatment if you’re diagnosed with a peptic ulcer. You will
    usually be prescribed a medicine called a PPI (proton-pump inhibitor) to reduce the amount of acid your stomach produces. It is also important to treat the cause which is commonly H.pylori infection by taking a course of two different antibiotics that your doctor will prescribe to clear the infection, and to stop medications such as ibuprofen.
    If untreated for a prolonged period it may lead to internal bleeding that leads to anaemia. Severe loss of blood causes bloody vomit or bloody stool and requires hospitalisation and blood transfusion.
    Peptic ulcer can cause perforation (hole) in the intestine which can attract infection in the abdominal cavity (peritonitis), that needs emergency surgery. Peptic ulcer may sometimes get inflamed causing obstruction that causes early satiety, nausea, vomiting and leads to inadequate food consumption.
    Surgery is usually reserved for complications of PUD.

  • It is a condition where your immune system attacks your own gut (small intestine) when you eat gluten. Gluten is found in food such as pasta, cakes, breakfast cereals, most types of bread, certain types of sauces, and some ready meals. Eating foods that contain gluten can
    trigger a range of gut symptoms, such as: diarrhoea, stomach aches, bloating and farting (flatulence),indigestion, and constipation. Coeliac disease can also cause more general symptoms like tirednessand unintentional weight loss, as a result of not getting enough nutrients from food.
    There's no cure for coeliac disease, but following a gluten-free diet should help control your
    symptoms and prevent the long-term complications of the condition. Even if you have mild
    symptoms, changing your diet is still recommended because continuing to eat gluten can lead to complications such as iron deficiency and vitamin B12 deficiency anaemia, and weakening of the bones (osteoporosis).

  • Constipation can mean different things to different people. There is a common belief that people need to open their bowel every day, but this is not the case. Opening the bowels can vary between three times a day to three times a week in healthy individuals. You have constipation if you open your bowel less than three times a week, or if you are passing a hard or pellet-like stool on more than a quarter of occasions, or if you need to strain to open your bowels on more than a quarter of occasions, or if you experience a sense of incomplete emptying after a bowel opening.
    There are three main physical causes for constipation;
    One of the causes is where the muscles of the intestine and large bowel stop working properly; this results in slow movement of contents through the bowel down to the rectum (leading to a reduced urge to empty the bowel and hard stools). This is termed slow transit constipation and patients have an infrequent urge to go to the toilet.
    Another type of constipation is called obstructed defaecation where the movement (transit) of the bowel is normal, but the person experiences symptoms of difficulty with emptying their bowel.
    Patients may need to strain, and feel they cannot empty. There are some patients who have both slow transit and obstructed defaecation.

    Finally, there is constipation-predominant Irritable Bowel Syndrome (IBS-C) when the person has difficulty with bowel opening and abdominal pain associated with not going. This type of
    constipation can be made worse with stress or depression.
    Most treatment is self-managed and based around dietary and lifestyle changes such as
    consumption of high fibre diet, increased oral fluid intake to 2 litres of uncaffeinated fluid per day, regular exercise, establishing a daily toilet routine, and learning the correct toilet posture by leaning forward and use of a foot rest to keep knees higher than hips. Occasional use of laxatives is not harmful, but you should discuss regular use of laxatives with your doctor. Laxatives are best to be used with proper guidance. Suppositories or mini-enemas are more predictable than laxatives and tend to be very well tolerated and effective especially for people who have difficulty with needing to strain to evacuate their bowel.

  • It is a lifelong condition where parts of digestive system become inflamed. The symptoms usually start in childhood or early adulthood. The main symptoms are diarrhoea, stomach cramps, bleeding from back passage, fatigue and weight loss.

    There's no cure for Crohn's disease, but treatment can help reduce or control your symptoms. The main treatments are medicines to reduce inflammation in the digestive system – usually steroid tablets, or medicines to stop the inflammation coming back – either tablets or injections.

    Around 1 in 5 people with Crohn’s will need major surgery in the first five years after diagnosis. You may be offered surgery if medicines are not controlling your symptoms, or if you develop severe complications. Surgery is an effective treatment option for many people. Many of the common surgeries for Crohn’s can be done by keyhole (laparoscopic) surgery. Common types of surgery for people with Crohn’s are strictureplasty (widening of intestinal strictures), bowel resection (with or without a stoma), and surgery for abscesses and fistulas.

  • It is a long-term condition where the large bowel and the rectum (which is the end of the large bowel where stool is stored) become inflamed. The main symptoms are recurring diarrhoea, increased bowel motions frequency, tummy pain, bleeding from the back passage, tiredness, loss of appetite, and weight loss. The severity of symptoms varies depending on how much of the rectum and colon is inflamed and how severe the inflammation is.
    The main aim of treatment is to reduce symptoms (known as inducing remission), and to maintain remission state. This usually involves taking various types of medicine that can be administered orally, or through a suppository or enema. If you have frequent flare-ups that have significant effect on your quality of life, or you have a particularly severe flare-up that's not responding to medicines, surgery would be an option.
    Surgery for ulcerative colitis involves permanently removing the colon (a colectomy). Once your colon is removed, your small intestine will be used to pass waste products out of your body instead of your colon. This can be achieved by creating: an ileostomy – where the small intestine is diverted out of a hole made in your tummy; special bags are placed over this opening to collect waste materials after the operation. Or an ileoanal pouch (also known as a J-pouch) –
    where part of the small intestine is used to create an internal pouch that's then connected
    to your anus, allowing you to poo normally.

    As the colon is removed, ulcerative colitis cannot come back again after surgery. But
    it's important to see a surgeon with special interest in inflammatory bowel disease to discuss
    the risks of surgery and the impact of having a permanent ileostomy or ileoanal pouch.

  • This is a technique that surgeons use to access the inside of the abdomen and pelvis without
    having to make large incisions in the skin. Other names include keyhole surgery, minimal invasive surgery, or minimal access surgery. The advantages of this technique over traditional open surgery include shorter hospital stay and faster recovery time, less pain and bleeding after the operation, and reduced scarring.
    Through small incisions that ranges between 1cm to 1.5cm, the surgeon is able to perform
    the required operation. After making an incision, the procedure starts with introduction of small tube that has a light source and a camera, and is connected to a television monitor. Carbon dioxide gas is pumped through the tube to inflate the abdomen. This allows the surgeon to see internal organs clearly and gives enough room to work. After the procedure, the carbon dioxide is let out of the abdomen, the incisions are closed using stitches or clips and a dressing is applied.
    Laparoscopy is now widely used in treatment of many conditions, such as: removing an inflamed appendix, removing the gallbladder, repairing different types of hernia, removing a section of the intestine in conditions like Crohn’s disease or for tumours, removing part of the large bowel for conditions like bowel cancer, diverticular disease, and ulcerative colitis. It can be also used for creating ileo-anal pouches for reconstruction surgery for ulcerative colitis, and for weight loss surgery.
    It is sometimes used as a diagnostic tool for unexplained pelvic or abdominal pain, and certain types of cancer. The laparoscope can be used to obtain sample of suspected cancerous tissue, so it can be sent to a laboratory for testing. This is known as a biopsy.
    Laparoscopy is a commonly performed procedure and it is considered safe approach. Your surgeon will discuss with you the possible risks according to the procedure that will be performed. Some of the gas used in laparoscopy can remain inside after the procedure, which can cause bloating, cramps and shoulder pain. These symptoms are not worrying and should pass after a day or so, once your body has absorbed the remaining gas.
    A relatively recent development in laparoscopy is the use of robots to assist with procedures. This is known as "robotic-assisted laparoscopy". Robotic-assisted laparoscopy allows surgeons to carry out complex procedures with increased precision and smaller incisions. The amount of robotic-assisted laparoscopy used in the UK has increased rapidly in recent years.

  • It is a downward slippage of the rectum from its position that leads to protrusion through the back passage. The prolapse can be internal and is found during an internal examination, or external where a lump can be seen coming out of the anus. It might be associated with prolapse of other pelvic organs like the womb (uterus), bladder, top of the vagina, and small bowel as well.
    The first thing you will notice is a lump sticking out of your back passage (anus). In the early stages this will only appear after you've had a poo or strained to pass a motion. It tends to disappear when you stand up. Later on, you may notice the lump in other circumstances that involve straining, like coughing or sneezing. Eventually, the lump may be noticeable most of the time and interfere with day-to-day activities such as walking. You may have to push the lump back with your hand.
    With internal prolapse you might not see or feel a lump, but instead you might experience
    symptoms like feeling of heaviness around the lower tummy or in the pelvis. It can also give you problems in passing motions, or leaking small amount of stool or urine.
    Initial treatment for early stages includes life style changes such as losing weight, preventing or treating constipation and pelvic floor exercises. Surgery will be required if non-surgical options have not worked or if the prolapse is more severe. Surgical repair can be done by abdominal procedures or through perineal procedures.

    Abdominal procedures: Involving opening the tummy or by keyhole surgery. The basic procedure is called a rectopexy, which involves placing the lower part of the bowel (the rectum) back into its original position and fixing it so it doesn't slip down again. Various methods are used to prevent slippage, including sutures, staples, slings and shortening the stretched bowel. This is most commonly done as keyhole surgery.
    Perineal procedures: These involve surgery in the area of the perineum which is located between the anus and testicles in men or the anus and lower part of the vagina in women. Variations include stripping some of the lining of the bowel off the prolapse, bunching up the bowel muscles with stitches, then replacing the lining (Delorme's procedure). The other option is pulling the rectum through the anus, removing a portion of the rectum and sigmoid colon, and stitching up the end of the bowel to the anus (Altemeier’s operation / perineal rectosigmoidectomy).

  • It is a broad term used to describe having difficulty passing stool through the rectum and anal canal (back passage) and the inability to achieve an adequate bowel movement. ODS can affect both men and women however it is more common in women.
    Symptoms often include a feeling of incomplete emptying of the bowel after stool is passed with a need to return to the toilet several times after to pass further stool to clear the bowel fully. Often it is difficult to ‘wipe clean’ after a bowel movement. Prolonged or excessive straining when passing stool, or a need to assist the passage of stool either by supporting the perineum or vagina internally with a finger (digitation) or manual evacuation are not uncommon. It can be associated with passage of hard stools / constipation, or occasional leakage of stool after a bowel movement.
    There are different causes for ODS, which could be either an internal rectal wall prolapse
    (Intussusception), or prolapse of small bowel down into the space between the vagina and rectum (Enterocele), or bulging and herniating of the rectum into the vagina (Rectocele).
    The initial measures to treat these symptoms are commonly by increasing your daily fibre intake and oral fluid intake, use of laxatives and glycerine suppositories to help achieving better bowel emptying. If the initial measures are not working, the use of rectal irrigation can be tried, which involves washing out the anal canal and rectum with water after a bowel motion to remove any stool that has not been passed naturally. Biofeedback can be helpful in more severe cases. This is a 12-week course of specialist physiotherapy to retrain the pelvic floor and is performed in the physiotherapy department. Biofeedback uses a combination of exercises and specially designed sensors to help stimulate the muscles within the pelvic floor helping you to both locate and strengthen or relax them. Approximately 60% of patients report a significant improvement in their obstructive symptoms with Biofeedback alone. It is also used before any surgery is undertaken to improve the overall outcome.
    For those failing to improve with these measures and with evidence of a structural cause for ODS such as an intussusception or rectocoele, surgery such as a rectopexy, or rectocoele repair may be indicated.

  • It is a clinical syndrome predominantly affecting young women, characterized by constipation and delayed colonic transit, occasionally associated with pelvic floor dysfunction. It is characterised by the slow movement of waste through the large bowel primarily due to reduced motility (peristalsis). Symptoms include infrequent motions, abdominal bloating / pain, nausea, and poor appetite.

    Treatment is mainly medical including diet and life style modifications, use of laxatives, and
    treatment and exclusion of any underlying possible causes such as low thyroid hormone levels, calcium levels abnormalities, and effect of any other medications. Surgery is rarely indicated as a last resort. Options include creating a stoma only, or removal of the affected part of the colon which can be the total colon with joining the small bowel back to the rectum or having a permanent stoma.

  • It is a condition that occurs when one or more open sores (ulcers) develop in the rectum. Solitary rectal ulcer syndrome is a rare and poorly understood disorder that often occurs in people with chronic constipation and straining during bowel movements. It can cause rectal bleeding, pain or feeling of fullness in the pelvis, and feeling of incomplete passing of stool. Despite the name, sometimes more than one rectal ulcer occurs in solitary rectal ulcer syndrome. Diagnosis is made by inserting a flexible tube with a camera through the back passage (flexible sigmoidoscopy). If a lesion is found, your doctor may take a tissue sample (biopsy) for laboratory testing.
    Treatment for solitary rectal ulcer syndrome depends on the severity of your condition. People with mild signs and symptoms may find relief through lifestyle changes, while people with more severe signs and symptoms may require medical or surgical treatment. Dietary changes, biofeedback exercises and trial of certain medications such as topical steroids or sulfasalazine enemas may help ease your rectal ulcer symptoms. Surgical procedures used to treat solitary rectal ulcer syndrome include: Rectal prolapse surgery (Rectopexy) if the condition is thought to be related to rectal prolapse, or Surgery to remove the rectum (Proctectomy) if you have severe signs and symptoms that haven't been helped by other treatments.

  • Haemorrhoids (piles): They are distended and swollen veins in the anus and lower rectum. They can present as fresh bleeding from back passage, itching and discomfort around anal area, and / or protruding lump from the anus. Haemorrhoids can generally be treated with diet modification, avoiding constipation and straining, and use of creams to ease the itching and swelling. If there is no improvement to your piles with these measures, simple procedures can be offered, such as;
    - Rubber band ligation: a band is placed around your piles to make them drop off
    - Sclerotherapy: a liquid is injected into your piles to make them shrink Surgical treatment might be required for larger piles, such as:
    - Haemorrhoidectomy: your piles are cut out
    - Haemorrhoidal artery ligation: stitches are used to cut the blood supply to your piles to make them shrink
    - Stapled haemorrhoidopexy: your piles are stapled back inside your anus

  • This is a tear or ulcer that develop in the lining of the anus. It causes sharp pain with passing motions, often followed by deep burning pain that may lest several hours. A small amount of red blood in the stool or on the toilet paper can be noticed. Initial measures of treatment include increasing your daily intake of daily fibres and oral fluid intake, laxatives, pain killers, ointments relaxing the sphincter muscle and increasing the blood supply to the fissure to help healing such as Glycryl trinitrate and Calcium channel blockers (Deltiazem). If this fail, injection of botulinum toxins in the anal region can be considered. This should prevent the muscle from spasming, helping to reduce pain and allowing the fissure to heal. There are other surgical options that can be considered if other treatments have not worked.
    - Lateral sphincterotomy: involves making a small cut in the ring of muscle surrounding the sphincter to help reduce the tension in your anal canal. This allows the anal fissure to heal and reduces your chance of developing any more fissures.
    - Advancement anal flaps: involve taking healthy tissue of the lining of the anus and lower rectum and using it to repair the fissure and improving the blood supply to the site of the fissure.

  • It is a small tunnel that develops from the inner lining of the end of the large bowel (rectum and anus), toward the surrounding skin around the anus. It is usually caused by an infection near the anus, which results in a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel behind. Anal fistulas cause unpleasant symptoms, such as persistent discharge, discomfort, and skin irritation. Surgery is often needed to treat anal fistulas as they do not usually heal by themselves. There are several different procedures for anal fistula. The best option for you will depend on the position of the fistula and whether it’s a single channel or branches off in different directions.

    - Fistulotomy: involves cutting along the whole length of the fistula to open it up, so it heals as a flat scar. It is the most effective treatment for many anal fistulas. But it's usually only suitable for fistulas that do not pass through much of the sphincter muscles. This is because the risk of incontinence is lowest in these cases.
    - Seton insertion: A seton is a piece of surgical thread that's left in the fistula for several
    weeks/months to keep it open. This allows it to drain and helps it heal, while avoiding the need to cut the sphincter muscles. If your fistula passes through a significant portion of anal sphincter muscle, a seton would be initially recommended. Loose setons allow fistulas to drain, but do not cure them. To cure a fistula, tighter setons may be used to cut through the fistula slowly, which require several procedures. Or carrying out several fistulotomy procedures, carefully opening up a small section of the fistula each time, or a different treatment.
    - Other procedures include Advancement flap procedure, Ligation of the intersphincteric fistula tract
    (LIFT) procedure, Endoscopic ablation, and Laser surgery. One of these procedures can be carefully selected to treat your anal fistula when indicated.

  • It is a sudden, cramping, severe pain around the back passage area that
    occurs on several occasions over few weeks, each time lasting only seconds to minutes. In between episodes, there is no pain at all. The cause is not exactly understood, but is believed to be due to spasms of the muscle of the anus. Most of the time it is not obvious what has set it off. It seems to be more common in people who have IBS, and people who have anxiety symptoms. In some cases, the pain can be triggered by having sex, being constipated, having a period, or during times of stress. If examination and further investigations are not showing any other conditions, there is often no treatment required. For many, the episodes are infrequent and can be reassured after being investigated. In a few people, it can be troublesome, and may need treatment. Simple pain killers and creams which work on the blood vessels around the anus, such as Glycryl trinitrate and calcium channel blockers (Deltiazem) can be tried.