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Treatment of Common Conditions

Haemorrhoids

Haemorrhoids or more commonly known as "Piles" have been afflicting mankind, probably since he started to walk on two legs. Haemorrhoids have been written about since the earliest times and are attributed to the cause of Napoleon’s quote “ not tonight Josephine”.

The surgical literature for Piles is littered with papers about the numerous ways to treat haemorrhoids. These all revolve around the destruction of tissue with various claims regarding post operative pain and resolution of symptoms. Again it is crucial that you discuss the various options available and that these are tailored to your needs.

Contrary to general opinion haemorrhoids are not usually painful unless they prolapse and become swollen. However, piles can cause troublesome rectal bleeding, itching and mucus seepage.

Pelvic floor problems

Symptoms of pelvic floor damage are difficulty in opening bowels, feelings of incomplete evacuation and needing repeated trips to the toilet to pass small amounts of faeces as well as difficulty in cleaning one’s bottom.

These usually, but not exclusively affect ladies. A major aetiological factor is child birth especially if it is traumatic requiring an episiotomy or forceps extraction. However, a Caesarean section does not completely protect the pelvic floor from damage.

Furthermore a hysterectomy can exacerbate this problem as structural support for the rectum is removed. Long term constipation and previous injudicious anal surgery as well as disorders of the bowel such as diverticular disease can worsen the problem.

Damage to the anal sphincter complex can lead to faecal incontinence. Symptom severity can vary from the occasional inadvertent loss of control of wind to sudden and without warning evacuation of faecal matter.

The treatment of pelvic floor problems is a complex area. Options available vary from the relatively straight forward such as pelvic floor exercises, biofeedback, injection of collagen to more complicated invasive surgical treatments. North Birmingham Colon Care has considerable expertise in diagnosing and treating these symptoms. Indeed it has introduced a number of these techniques such as sacral nerve stimulation (SNS) to North Birmingham.

If you have suffered a significant obstetric injury during child birth it is prudent to seek advice as to whether a Caesarian section may minimise further pelvic floor damage.

Early rectal cancer

With the commencement of the National Screening Programme for Bowel Cancer there has been an increase in the number of early rectal cancers diagnosed. The routine treatment for this has been major abdominal surgery to remove the rectum, often necessitating a stoma (often referred to as a ‘bag’: the colon is brought to the surface of the abdomen and opened, so that waste matter goes into a bag). However, it is possible to perform a local excision alone preserving the function of the rectum, provided the tumour is an early cancer. Specialised techniques such as 3-D endo rectal ultrasound are required to accurately assess the lesion, and trans anal endoscopic microsurgery (TEMS) is the gold standard to remove these lesions surgically. Both are performed routinely by NBCC surgeons with the largest experience in the West Midlands. Currently, the Birmingham centre for the management of these early rectal cancers is based at Good Hope hospital and provided by members of NBCC.

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