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Symptoms
Bowel problems can effect people at any age and are often embarrassing
as well as incapacitating. The following are typical symptoms that
patients complain of
- Rectal bleeding
- Anal pain
- Painful desire to defecate
- Urgency to defecate
- Anal itch
- Lump at the anal verge
- Prolapse of rectum or haemorrhoids on defecation
- Anal leakage
- Change of bowel habit
- Diarrhoea
- Constipation
- Abdominal pain
- Anaemia
- An abdominal mass
Working out the cause of the symptoms is a job for your doctor
and a colorectal surgeon.
Important symptoms which may be due to bowel cancer include
- Blood mixed with the stool
- Rectal bleeding without anal symptoms
- Change of bowel habit persisting for more than 6 weeks (but
less than 6 months)
- Iron deficiency anaemia
- Abdominal or rectal mass
- Some patients with bowel cancer have no symptoms and the tumour
is detected at screening. There is no blood test for bowel cancer.
Investigations
Colonoscopy is the visual examination of the inner surface of the
colon by means of a colonoscope. Colonoscopies may provide a visual
diagnosis and allows the opportunity for biopsy of suspected lesions.
Colonoscopy
is done after bowel preparation which can be done at home. The test
is done as a day case under sedation.
Virtual colonoscopy, which uses 3D imagery reconstructed from computed
tomography scans, is also possible, as a totally non-invasive medical
test, although it is not standard. A colonoscopy may be required
after the CT to take biopsies from any abnormality found.
CT scan CT stands for computerised tomography. This is an XRay
test which is quick safe and painless.
MRI scanning magnetic resonance imaging is used to evaluate rectal
tumours and liver lesions. It is painless but may require the patient
to lie in a semi-enclosed space for a up to an hour.
Barium enema is an XRay of the bowel which requires bowel preparation
and introduction of contrast fluid via the anus. A barium enema
is generally reserved for patients where it has not been technically
possible to do a complete colonoscopy as biopsies cannot be done
at barium enema.
Futher information on MRI can be found here
Colostomy and ileostomy (stomas)
What is a stoma?
A colostomy is a surgically made opening of the large bowel onto
the abdominal wall. The waste passes into a bag or colostomy appliance
rather than through the rectum and anus. An ileostomy is a similar
opening in the small intestine. Together they are termed stoma.
Why are stomas formed?
Stomas are made to divert faeces away from the bowel beyond the
stoma. This may be done in order to protect a join up after surgery,
to relieve obstruction if the blockage is not treatable or because
the anal sphincter has been removed or is diseased and ineffective.
Can stoma be reversed?
Some stomas are designed to be permanent for example after complete
removal of the rectum and anus for cancer. If a stoma can be reversed
the risks and benefits need to be carefully weighed up. Keyhole
surgery can be employed to reverse some types of stoma in particular
after a Hartmann’s procedure. The
patient’s story
Further
information can be found here
Anal problems including haemorrhoids
or piles are poorly understood by the general public and non
specialist doctors. Any anal problem is put down to “piles”.
There are many anal pathologies which require correct diagnosis
before the appropriate treatment can be given. |
Haemorrhoids
What are haemorrhoids?
Haemorrhoids or piles are abnormalities of the anal canal which
can give rise to bleeding and prolapse.
How are piles graded?
Haemorrhoids are classified as first degree if they bleed but do
not prolapse. Secondary if prolapse returns spontaneously. Tertiary
if manual reduction is required. Skin tags may be associated with
haemorrhoids especially if advanced.
What treatments are available?
Good diet and regular toilet routine help. Injections are painless
and reduce bleeding. Once prolapse is problematic destruction with
bands or an operation may be advised.
What
is a stapled haemorrhoidectomy (PPH)?
Skin tags can develop after any anal problem
and may become inflamed and give rise to hygiene problems.
Puritis or itch is a common distressing
problem. The cause needs to be identified before treatment is given.
Fibro-epithelial polyps develop in the
anal canal and often prolapse.
Anal fissure
What is an anal fissure?
An anal fissure is a small tear at the anal verge.
What are the symptoms?
Anal fissure causes anal pain on defecation or following defecation.
Bright red bleeding may occur.
What is the cause?
Fissure can follow passage of a constipated stool, childbirth or
other causes including diarrhoea. Local pain causes anal muscular
spasm which stops the patient relaxing the anal muscles so that
a self perpetuating situation occurs.
What is the treatment?
Treatments are designed to reduce anal muscular spasm. Muscle relaxant
creams such as 0.3% GTN are often effective. Surgical incision (sphincterotomy)
is reserved for resistant cases.
An abscess is a painful collection of puss
which follows infection of anal glands and can lead on to fistula.
Anal fistula
What is an anal fistula?
An anal fistula is an abnormal connection between the anal canal
and the skin. As the sphincter is bypassed leakage of anal mucous
and stool can occur. Fistulas are defined as high or low depending
on the relationship to the anal sphincter muscles.
What are the causes?
Fistulas commonly follow a perianal abscess.
What is the treatment?
Treatment is by operation. Low fistulas not crossing the sphincter
may be laid open of excised. High fistulas are often treated by
a seton. A seton is a nylon thread which is passed through the fistula.
Setons drain infection and gradually migrate to the skin leading
to a controlled sphincter division with healing preserving faecal
continence.
Anal cancer differs from rectal cancer
in the cell type and non surgical treatment is routine in the first
instance.
Rectal prolapse
What is rectal prolapse?
Rectal prolapse is decent of the rectum through the anal canal so
that it protrudes between the buttocks.
Rectal prolapse in adults is most commonly seen in older people
especially women. Rectal prolapse may be associated with uterine
prolapse and urinary stress incontinence.
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