Surgical Treatments

Many common bowel conditions can be treated effectively without surgery. However, when a condition becomes more advanced or complex, surgery is sometimes necessary.

Surgical procedures for bowel conditions are continually evolving and improving. Wherever possible, your doctor will recommend the least invasive surgical option although this will be determined by the type and severity of the condition, as well as other factors such as your age and general health and wellbeing.

All of these techniques are proven to be effective.

Anal Conditions

Haemorrhoids:

  • THD – Transanal haemorrhoid dearterialisation is a minimally invasive procedure used to treat haemorrhoids. The blood supply to each haemorrhoid is located using an instrument called a proctoscope. Each of these arteries is then sutured, causing the haemorrhoid to wither. The procedure is highly effective and there is less risk of bleeding than with conventional banding techniques. You can generally resume normally activities in one to two days after treatment.
  • Ligasure haemorrhoidectomy – Whereas conventional haemorrhoid surgery involves cutting away the haemorrhoids, ligasure haamorrhoidectomy uses a high frequency current to coagulate the tissue. The result is less pain and faster recovery.
  • Formal haemorrhoidectomy – Haemorrhoids are cut out under general anaesthetic.
FAQ's
Haemorrhoids Treatment

The condition can be made worse by heat, moisture around the anus which may be caused by sweating or incomplete drying after washing, poo coming into contact with the skin around the anus, stress and anxiety. Be careful to wipe your bottom thoroughly after going to the toilet and always dry yourself properly after washing. Try to avoid scratching the itch which can make it worse.

It is believed that up to five in every 100 people may suffer from an itchy bottom. The condition is more common in men than women and most often affects people between the ages of 40 and 60. However, anyone can be affected, including children.

Certain foods when they are not fully digested are known to irritate the skin around the anus when you go for a poo. These include: citrus fruit, grapes, tomatoes, spices and chilli, milk, beer and caffeine. There are lot of other potential causes too so it is a good idea to talk to your doctor to try and identify the root cause.

Anal Pain:

Botox injections – see under Anal Fissure.

FAQ's
Anal Pain Treatment

Anal pain can be caused by a number of factors including haemorrhoids, anal fissures, anal spasms, and other less common causes including cancer, prostate problems and foreign bodies.

You should not need to seek urgent medical attention for anal pain unless: you start to bleed from your bottom, or the pain is becoming severe, or you have something stuck up your bottom.

When you have an anal spasm attack, it is normally short-lived although it can be intensely painful. Your doctor may suggest muscle relaxers, asthma medication, ointments to improve blood flow to the anus or Botox.

Anal Warts:

Surgery to remove anal warts is normally performed under general anaesthetic unless the warts are very small in which case a local anaesthetic will be used. The main types of surgery are:

  • Diathermy – burning the warts off using a low voltage electric current passed through a thin wire or probe.
  • Surgical removal – using a scalpel. The area is then stitched.
FAQ's
Anal Warts Treatment

The cream appears to boost your immune system to help your body fight the virus that causes warts. While using the cream you should avoid sexual contact as it can weaken condoms and diaphragms and may irritate your partner’s skin.

Trichloroacetic Acid (TCA) is a chemical treatment that is used to burn off genital warts, including internal warts. It can cause some skin irritation and pain but is an effective treatment.

No, these treatments are not suitable for the delicate anal or genital area and may cause irritation and pain.

Pilondial Disease:

  • Excision and primary closure – If you have a large sinus or one that becomes infected repeatedly, this procedure removes the sinus and an oval-shaped flap of skin is cut out on either side of the sinus. The two sides are stitched together causing a flattening of the groove between the buttocks. It is carried out under general anaesthetic.
FAQ's
Pilondial Disease Treatment

Pilonidal cysts normally occur either when:

  • a hair follicle becomes irritated or stretched, which may occur during certain types of exercise such as horse riding or cycling
  • a loose hair gets trapped in the crease between the buttocks

Your doctor will carry out a physical examination.

Keep the area dry and clean. If the cyst becomes infected, soak it in warm water several times a day and use antibacterial soap or an alcohol swab to clean the area if your doctor instructs you to do so. You can take over the counter painkillers if necessary.

Anal Fissure:

  • Botox injections – This is a relatively new treatment for anal fissures. An injection of the Botulinum toxin can be used to relax your sphincter muscle, helping to prevent it from spasming, thereby reducing pain and allowing the fissure to heal.
  • Advancement flaps – This treatment is normally used for patients for whom other anal fissure surgery has failed. It entails taking healthy tissue from from around the anus and using it to repair the fissure.
  • Lateral spincterotomy – This is for people with chronic anal fissures. By dividing a small part of the internal anal sphincter, it lowers the resting pressure of the internal anal sphincter. This improves blood supply to the fissure and allows for faster healing. The treatment is only for selected patients due to the risk of incontinence.
FAQ's
Anal Fissure Treatment

Gently clean and dry your bottom after going for a poo but be careful to avoid scented soap or bath oil. Soaking your bottom in the bath can help to reduce pain and promote healing.

Take measures to reduce constipation and prevent poos from becoming large and hard. Increase your fibre intake (fresh fruit and vegetables, brown rice and bread), drink plenty of water, go for a poo when you need to go and talk to your doctor about other preventative measures.

Coconut oil is an excellent moisturiser and gentle enough to use on the anus. As well as tackling dryness and soreness it also appears to help to heal the wound.

Anal Fistula:

Sphincter-preserving techniques:

  • Seton – placing a piece of surgical thread (a seton) into the fistula and leaving it there for several weeks to help it heal.
  • LIFT procedure – Litigation of the interspincteric fistula tract is one of the newer treatments for anal fistulas. It involves identifying the fistula in between the internal and external sphincter, before dividing the fistula tract and sealing both ends so that the tunnel ends are disconnected.
  • Mucosal advancement flaps – cutting or scraping out the fistula and covering the hole with a flap of tissue taken from inside the rectum.

Sphincter-sacrificing techniques:

  • Fistula lay-open – cutting open the whole length of the fistula so it heals into a flat scar.

Abscess:

Surgical drainage and removal under general anaesthetic. Normally the abscess is left open to drain and heal.

FAQ's
Abscess Treatment

You may be given antibiotics to treat an abscess but these might not be enough to clear the infection completely and the abscess might need to be drained. If an abscess isn’t drained it can continue to fill with pus and could eventually burst which is painful and can cause the infection to spread.

It appears as a painful boil-like swelling near the anus. It may feel warm to the touch, red, shiny and swollen. Abscesses in the deeper anal tissues are less visible and also less common.

Around 40 percent of people who have an anal abscess go on to develop a fistula. This is a small tunnel from the site of the abscess to the skin. It can result in recurrent anal abscesses and will almost always require surgery.

IBD

Crohn’s Disease:

  • Single incision small bowel resection – a minimally invasive surgical technique that is suitable for some Crohn’s patients.
  • Stricturoplasty – surgery to widen a narrow area of the small intestine where it is affected by the disease. No part of the intestine is removed.
  • Ileo-caecal resection – removing the last part of the small intestine and the first part of the colon where they have been damaged by the disease.
  • Ileo-rectal anastomosis – removing the colon and joining the last part of the small intestine (the ileum) to the rectum.
  • Proctocolectomy – removing the colon and rectum.
  • Stoma – creating a small temporary opening on the surface of the abdomen to divert the flow of faeces into an external bag.
FAQ's
Crohn’s Disease Treatment

There is currently no known cure for Crohn’s Disease. However, there are treatments to help you manage the symptoms and prevent complications. These include anti-inflammatory drugs, immune system suppressors, antibiotics, nutrition therapy and surgery. Your doctor will advise on the best type of treatment for you.

Some foods can trigger the symptoms of Crohn’s Disease. You should try and avoid: alcohol, butter and spreads, carbonated drinks, high fibre foods, coffee tea and chocolate, dairy products. It is a good idea to keep a food diary so that you can identify the foods that are triggers for you.

Yes. Inflammation in the digestive tract can result in serious complications such as infections, fistulas, bleeding and perforation of the intestinal wall. When the condition flares up you may need to spend time in hospital, leading to disruption in your everyday life.

Ulcerative Colitis:

  • Single incision ileo-rectal anastomosis – see description under Crohn’s.
  • Ileal pouch anal anastomosis – this involves removing the rectum and colon to form what is often referred to as a J-pouch. The procedure is carried out in one – three stages depending upon the severity of your condition, with each operation being performed approximately three months apart.
  • Proctocolectomy – see description under Crohn’s.
  • Stoma – see description under Crohn’s.
FAQ's
Ulcerative Colitis Treatment

The exact causes are unknown but genetics and environmental factors are believed to play a part. It is an autoimmune condition which means the body’s immune system starts to attack healthy tissue, in this case the lining of the colon.

Ulcerative colitis is normally treated with anti-inflammatory drugs. The precise drugs will be determined by the severity of your condition. You may also be given immune system suppressors which reduce inflammation by suppressing the immune system. Other drugs to control the condition may be given, including antibiotics, iron supplements and painkillers.

Ulcerative colitis leads to an increased risk of colon cancer. As a result you will normally be offered regular colonoscopies to screen for the disease.

Pelvic Floor Disorders

Incontinence:

  • Sphincter repair – a surgical procedure to repair a damaged or weakened anal sphincter.
  • Rectovaginal fistula repair – surgery to correct the leakage of poo or gas into the vagina from the anus. The fistula is divided and repaired with healthy tissue from between the rectum and vagina.
FAQ's
Incontinence Treatment

A range of treatments can help to treat incontinence, including biofeedback therapy, which is used to treat urge and passive incontinence. The treatment works by slowly increasing how long you can wait before having to open your bowel.

This is a technique for learning to control a bodily function that is not normally under your conscious control.

There are a number of diagnostic tests. Your doctor is likely to perform a rectal examination to evaluate the strength of your sphincter muscle and check for abnormalities.

Other tests include the anorectal manometry and endoanal ultrasound. These tests involve first inserting a small pressure recording device into the rectum, which is then removed and an ultrasound probe is then inserted into the rectum. These tests take approximately 5 minutes and give detailed information about any abnormalities of the sphincter muscle.

Prolapse:

Mesh is a synthetic or biological material that is sometimes used to support, reinforce or replace the tissue that holds the rectum in place. We avoid using mesh for prolapse surgery, which is when the rectum protrudes outside the anus, because it can become infected as the body regards it as a foreign body. We offer a number of highly effective surgical procedures to repair a prolapse that do not involve mesh. These include:

  • Delormes and Altemeire’s procedures – two different types of surgery to repair an external rectal prolapse without making a cut in your abdomen.
  • Suture rectopexy – a keyhole surgery technique to repair a rectal prolapse.
  • Resection rectopexy – a keyhole surgery procedure that repairs a rectal prolapse by removing the segment of bowel which prolapses out of the anus.
FAQ's
Prolapse Treatment

Complications can include vaginal pain, infection, abscesses, abnormal discharge, damage to adjacent organs, or urinary fistula. For this reason we avoid using MESH in prolapse repair surgery.

A prolapse tends to cause discomfort rather than acute pain. Very rarely a prolapse will become extremely painful and it will not be possible to push it back into the pelvis because the blood supply is blocked, if this occurs you must go to accident and emergency immediately.

A prolapse does not generally improve without surgery. In most cases a prolapse will worsen over time and surgery becomes essential.

Constipation:

  • Colectomy – surgery to remove all or part of the colon.
  • Ileo-rectal anastomosis – see under Crohn’s Disease above.
FAQ's
Constipation Treatment

Doctors normally advise eating more of some foods and less of others. Fibre-rich foods such as fruit and vegetables, brown rice or pasta, wholemeal bread, beans and pulses can all help, along with drinking plenty of water. Try to avoid too many dairy products, red meat, chips, fatty foods, ready meals and bananas.

There are a number of factors that can contribute to constipation. Most common is not eating enough fibre or drinking enough water. However, you can also be affected by a change in routine or lifestyle, anxiety and depression, ignoring the urge to poo and taking certain medication.

You may be able to treat constipation yourself by making some simple changes, such as improving your diet and drinking more water. However, if this doesn’t help and the problem becomes chronic you should speak to your doctor.

Colon and Rectal Cancer

Colon cancer:

  • Keyhole surgery.
  • Single incision bowel removal.

Rectal cancer:

  • Keyhole surgery.
  • Single incision rectal removal.
  • TEMS – transanal endoscopic microsurgery is used to remove early stage rectal cancer through the anus without having to make any incisions. The procedure is less invasive with fewer complications and faster recovery times than surgery that requires incisions.

Advanced/recurrent cancer

  • Pelvic exenteration – removal of some or all of the organs inside the pelvis.
  • Intra operative radiotherapy – targeted single dose of radiotherapy during surgery to decrease risk of advanced pelvic cancers recurring.
  • HIPEC – hyperthermic intraperitoneal chemotherapy is a highly concentrated heated chemotherapy treatment delivered straight into the abdomen during surgery.
FAQ's
Colon / Rectal Cancer Treatment

There are steps that you can take to reduce your risk of developing colon and rectal cancer but you cannot alleviate it completely. You may want to consider: reducing your consumption of red and processed meat, eating more fruit and vegetables, reducing your alcohol intake, taking regular exercise and losing weight if you are obese.

No. Blood in your stool can be caused by other conditions such as haemorrhoids and anal fissures but it is important to get it checked out as blood in your stool can be an indicator of bowel cancer.

It is important to catch bowel cancer as early as possible to stand the best chance of successful treatment. Bowel cancer affects around 41,000 people every year. It can be successfully treated if identified before it has had a chance to spread. If polyps are found in the bowel early enough they can be removed even before they become cancerous.

The majority of colon and rectal cancers occur in people with no family history of the disease. However if you have a close family member who developed the condition before the age of 60, you will be at increased risk and may be offered additional screening.

Experienced bowel doctors, here to help you

The sooner you seek help, the sooner your chances of returning to health and getting your life back on track.

There really is nothing to feel embarrassed about and everything to be gained by coming to talk to our specialists.

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