Irritable Bowel Disease awareness

Know the signals and the symptoms to irritable bowel syndrome – a common disorder that affects 30% of adults

IBS – the facts

This very common gastrointestinal disorder affects up to 30% of the adult population.

Classical symptoms are of cramping abdominal

pain, abdominal bloating, alteration in bowel

habit, either diarrhoea or constipation,

mucus discharge, incomplete evacuation of

faeces and gastroesophageal reflux disease

(GORD). The persistence of these symptoms,

or the passage of blood through the rectum,

should initiate a referral to your GP.

IBS is assumed to be associated with abhorrent signals

between the brain and the gut. It can also be

triggered by a severe infective episode of

gastroenteritis, or it can even be stress related.

Managing the condition

Investigation after concise history taking and

examination can often be managed on an

outpatient basis, following basic blood tests

(thyroid function test, coeliac screen) and stool

tests. 

In the presence of persisting symptoms such as constant diarrhoea

or rectal bleeding, colonoscopy may be required, especially when

over the age of 35, to exclude an alternative cause for the symptoms.

Management often involves certain dietary

modifications, for example, the low FODMAPS

diet has gained increasing acceptance recently

for improving symptom control. 
Refractory IBS can often be managed with good symptomatic

outcomes through avoidance of precipitating

factors, various relaxation techniques and bowel

retraining techniques.

Contact us 

Vist Us online at http://www.colorectalspecialists.co.uk

Risk factors for colorectal cancer

Concerns regarding colorectal cancer remain a topical issue, primarily because of its common nature with over 30, 000 new cases being diagnosed on an annual basis in the UK alone.

It is the third most common cancer in the UK. In addition, there has been increased exposure to the disease, since the government introduced the national screening programme, in an effort to reduce the significant implications associated with the diagnosis of advanced disease.

So what are the risk factors ?

Age. Colorectal cancer is a disease that primarily affects people over the age of 50. It can however occur at a younger age, but is less common. Despite this in a symptomatic individual (see below) irrespective of age, but especially over the age of 35, there is a low threshold to investigate.

Family history of colorectal cancer (CRC) or high risk colon polyps.

Patients with a family history of either of the above have an increased risk of developing the disease and thus require further investigation. The presence of a first degree relative who has developed CRC under the age of 60 (in particular under the age of 45) or alternatively has a family history of multiple cancers should be referred for early colonoscopy and genetic surveillance.

Previous surgery for colorectal cancer

Will require long term surveillance.

Chronic inflammatory conditions of the colon

Ulcerative Colitis and Crohns disease increase the risk of developing colorectal cancer.

Diabetes & Obesity

Patients with diabetes or who are obese have an increased risk of colorectal cancer.

Diet

There is a weak association between eating large amounts of red meat and colorectal cancer.

Smoking and Alcohol

Excessive consumption of either is associated with an increased risk of colorectal cancer.

What measures are undertaken in the clinical setting?

New onset symptoms are actively pursued during consultation, in all age groups, primarily to exclude alternative diagnoses. It is important to maintain a high index of clinical suspicion, with increasing age.

High risk symptoms

•                Rectal bleeding with altered bowel habit (loose stools for more than 6 weeks)

•                Rectal bleeding in the absence of anal canal symptoms eg itching

•                Increased frequency of bowel movements for more than 6 weeks

•                Palpable abdominal mass or rectal mass

•                Iron deficiency anaemia

Low risk symptoms

•                Transient change in bowel habit, less than 6 weeks (e.g constipation)

•                Persisting abdominal discomfort, (age more than 50, there is a 10% association with intra abdominal malignancy)

•                Impaired Glucose tolerance (type II diabetes).

The patient pathway

Having undertaken a concise history and following a thorough examination, a rigid sigmoidoscopy is undertaken in clinic.

Thereafter flexible sigmoidoscopy, colonoscopy or alternatively CT pneumocolon will be undertaken on an elective basis to establish an aetiology for the symptoms described.

If further intervention is indicated, the use of minimally invasive techniques such as keyhole surgery enhances recovery, enabling a more rapid return to normal activity, with minimal lifestyle disruption.

Related Guides Children Parent

Mr Romi Navaratnam  MSc MS  FRCS (Lon) FRCS (Gen)

Consultant Colorectal & Laparoscopic Surgeon/Hon. Senior Lecturer in Surgery

http://www.colorectalspecialists.co.uk/

Secretary:             020 7078 3832                            Fax: 0207 078 3898

Appointments        020 8887 2241                            North Middlesex University Hospital

Royal Free & UCL Medical School

Appointments        020 7806 4060                            Hospital of St John & St Elizabeth

020 7483 5181                            Wellington Hospital (Central)

Correspondence: Hospital of St John & St Elizabeth 60 Grove End Road London NW8 9NH

05 May 2011

Haemorrhoids: What are they?

Haemorrhoids: What are they?

Haemorrhoids (or piles, which is their alternative name) 

are vascular cushions (lined by blood vessels), which are very 

common. It is quoted that over 50% of adults over the 

age of 50 have haemorrhoids and experience symptoms 

compatible with haemorrhoids. However, they can occur 

at any age. They have a role in the maintenance of continence 

(the prevention of accidents from the back passage and the 

inappropriate passage of wind, liquid or solid stools).

What causes them?

Prolonged straining when going to the toilet, often associated with constipation and sitting on the 

toilet for long periods of time are thought to be associated with the development of haemorrhoids. 

The theory is that the perineal muscles (pelvic floor) remain unsupported during protracted straining 

on the loo.

How do they present?

There are a wide variety of symptoms, but namely, bleeding and discomfort from the back passage, 

both of which may be associated with other benign conditions (such as anal fissure), 

itching (pruritus ani) or a small lump at the anal verge. If bleeding is identified then it is imperative,

that other sinister conditions should be excluded through 

colonoscopy (telescope test of the back passage) or a CT pneumocolon (in the appropriate age group).

Management

In the majority of cases, haemorrhoids can be managed entirely conservatively 

(i.e. do nothing and adopt a watch and wait policy). The most important aspect, is to exclude an 

alternative cause for the symptoms, especially in the presence of rectal bleeding or other symptoms 

such as ongoing constipation or diarrhoea. The conservative options available in the 

outpatient setting include dietary advice (eating a diet high in natural fibre), 

injecting haemorrhoids (injection sclerotherapy) or alternatively haemorrhoidal banding. 

The latter are associated with very low risks e.g. recurrent bleeding or post procedure discomfort, 

more so with banding.

Surgery

For patients with refractory symptoms, i.e. persistent symptoms that have not been improved by 

the conservative measures described and where symptoms affect quality of life, the options 

available are either conventional haemorrhoidectomy, which in the past has had bad press, 

in view of the perceived complications, namely post operative pain. However, this is less so now.

Techniques such as stapled haemorrhoidectomy have been practised for over 10 years and is 

particularly good for symptoms of haemorrhoidal prolapse. More recently, 

the haemorrhoidal artery ligation technique (HALO) has been increasingly used as a technique with 

encouraging results and less post operative discomfort.

The complications associated with surgery are low, but include post operative pain, recurrent bleeding 

and to a lesser degree narrowing of the anus (stenosis).

Summary

Haemorrhoids are extremely common. The most important concept regarding their management 

is to exclude alternative pathology, especially in the presence of rectal bleeding, through ideally 

colonoscopy. This is to exclude any sinister lesion which can masquerade with identical symptoms. 

The large majority of patients can be managed entirely conservatively, without recourse to surgery. 

However, should symptoms prove to be problematic and impact on life style, then surgery is the 

best long term option, assuming that the other conservative options described have been exhausted 

prior to this.

Mr Romi Navaratnam  MSc MS  FRCS (Lon) FRCS (Gen)

Consultant Colorectal & Laparoscopic Surgeon/Hon. Senior Lecturer in Surgery

http://www.colorectalspecialists.co.uk/

Secretary:             020 7078 3832                            Fax: 0207 078 3898

Appointments        020 8887 2241                            North Middlesex University Hospital

Royal Free & UCL Medical School

                                                                              

Appointments        020 7806 4060                            Hospital of St John & St Elizabeth

                              020 7483 5181                            Wellington Hospital (Central)

Correspondence: Hospital of St John & St Elizabeth 60 Grove End Road London NW8 9NH

05 May 2011