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.
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 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.
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 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.
Mr Muti Abulafi is a highly skilled consultant surgeon with over 30 years' experience in both colorectal and general surgery. He has a special interest in colorectal cancer care and currently acts as lead for the colorectal cancer multidisciplinary team at Croydon University Hospital. His other specialist interests include colorectal and keyhole surgery, colonoscopy, inflammatory bowel disease, pelvic floor dysfunction, and hernia operations. Mr Abulafi takes a keen interest in research, and has published extensively on colorectal cancer and cancer genetics. He is actively involved in training and education, having helped found and establish the annual M25 colorectal course, which teaches trainee surgeons and educates them on all aspects of colorectal surgery. Mr Abulafi is a member of several specialist surgical associations in the UK and Europe and is the current Chair of the Colorectal Cancer Pathway Group at the Royal Marsden Partners Cancer Vanguard.
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:
Screening aims to determine whether healthy people show any early signs of bowel cancer. Bowel cancer is a common form of cancer for men and women, with approximately 1 in 20 people experiencing it in their lifetime in the UK. Detecting early signs of risk for bowel cancer can ultimately save lives. Bowel cancer in its early stages is more likely to be treated successfully.
In the UK, people over the age of 60 are invited to be screened. Following this, you are invited every two years for screening until the age of 75. Screening involves home tests that detect blood in the stool. If you are registered with a GP in the UK, you will automatically be sent this home test after the age of 60.
Additionally, at age 55 you are invited for a one-off bowel scope screening test (also known as a flexible sigmoidoscopy) where a thin tube with a camera is used to examine the inside of the bowel. This test can detect polyps, which are small growths that could eventually turn into cancer. If polyps are detected, they can be removed.
Bowel cancer screening is offered because it can save lives by detecting early signs of bowel cancer, or your possible risk of developing it. The earlier it is detected, the more successful treatment is likely to be.
For the bowel scope screening, a few weeks before the appointment you will be sent a small plastic pouch containing liquid to perform an enema before the test, as well as instructions on how to do this. On the day of the test you will need to use the enema kit. This will induce a bowel movement before the test. You will also need to wear a hospital gown for the test.
For the home test kit, no preparation is required.
During a bowel scope screening, the camera tube is inserted gently into your bottom to check for polyps. This test is painless, but you might find it slightly uncomfortable. No anaesthesia is required. The test lasts just a few minutes and you return home soon after the test is finished.
The home test kit is for sending a small poo sample to be tested in a laboratory. You will receive instructions on how to take a stool sample with the kit.
Following the bowel scope test, if polyps are found you are told immediately following the test. If polyps are found and removed but are not cancerous you might also be offered a colonoscopy to check for polyps elsewhere in the bowel. If cancerous polyps are found and removed, you will be referred to a bowel cancer specialist to discuss treatment.
A normal result from a home test kit would indicate no blood in your stool, with no further action required other than another home test kit in two years’ time. If blood is found in your stool sample you will be offered a colonoscopy to do a more thorough investigation.
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 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.
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.
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.
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.
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.
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.
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:
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.
Pelvic floor reconstruction is a surgical procedure involving the repositioning of the internal organs of the female pelvis.
The goal of pelvic floor reconstruction is to position pelvic structures in a manner that corrects urinary and/or faecal incontinence, pelvic disease and pelvic symptoms while preserving sexual function.
Pelvic floor reconstruction is performed to achieve correct positioning of the internal organs of the female pelvis: uterus, bladder and rectum. The procedure involves placement of a polypropylene mesh.
There are different ways to perform it: vaginal route, abdominal route, laparoscopically (minimally invasive) or a combination of these.
The vaginal route is the most common.
Before undergoing pelvic floor surgery, it is advisable to undergo a course of vaginal physiotherapy to strengthen the musculature of the area for the intervention.
When performed as minimally invasive surgery, the surgical procedure is shorter and recovery is faster. You can resume your normal routine one week after the operation. If the surgery is performed through the vaginal or abdominal route, your surgeon will advise what type of post-operative care is necessary and how long you will need to rest.
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 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.
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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