General Surgeon, Darwin

 

Haemorrhoids

Haemorrhoids, commonly known as piles refer to a condition in which the veins around the anus or in the rectum become swollen and inflamed. Majority of people may suffer from haemorrhoids at some point in their life time. It is more common in individuals aged between 45 and 65 years and in pregnant women.


What causes haemorrhoids?

Factors include chronic constipation and diarrhoea, excessive straining during bowel movement, diet which lacks fibrous food, aging (weak connective tissue in the rectum and anus) and pregnancy (increased pressure in the abdomen). Haemorrhoids may come on with no known cause.

Symptoms

The most common symptom is passage of bright red blood with the stools. If the haemorrhoids have prolapsed, it causes pain, discomfort and itching around the anus. Blood clots may form in the swollen veins causing bleeding, painful swelling or a hard lump.

Diagnosis

Haemorrhoids are often diagnosed at physical examination, which involves digital rectal exam with a gloved, lubricated finger. Additional diagnostic tests are often needed to rule out other causes of bleeding (such as cancer), including flexible sigmoidoscopy, colonoscopy or rarely Barium enema X-ray.

Treatment

Lifestyle modifications and dietary changes often are helpful in reducing the symptoms of haemorrhoids. A diet having high fibre content soften the stools and helps to pass them easily thereby avoids straining. Fruits, vegetables and cereals serve as a good source of dietary fibres. Fibre supplements such as methylcellulose or stool softeners can be taken. Drinking plenty of water and adequate exercise helps prevent constipation. Over-the-counter creams and suppositories help relieve the pain and itching. However, these are short time remedies as long-term use can cause damage to the skin.

Medical Treatment

The simplest medical treatment is rubber band ligation, where a special rubber band is placed around the base of the haemorrhoid. This band obstructs the blood circulation causing the haemorrhoid to shrink. The procedure is commonly performed under anaesthesia and is usually painless afterwards. Sclerotherapy involves injecting a chemical solution into the blood vessel so that the haemorrhoid shrinks.
Surgical removal (haemorrhoidectomy) becomes necessary when the haemorrhoids are large enough and do not respond to conservative treatment.

Diverticular Disease

Diverticular disease is very common. One-third of Australians over 45 years of age, and two-thirds over 85 years have some diverticular disease. Many are unaware they have it. The main cause is not eating enough fibre.
Diverticulosis is the formation of abnormal pouches in the bowel wall, but without any symptoms. Diverticulitis is the inflammation or infection of these pouches. These conditions are collectively known as diverticular disease.
Only about a quarter of people with diverticular pockets develop symptoms, which may include pain in the lower abdomen together with feelings of sickness or nausea, bloating and loss of appetite.
A colonoscopy, CT Scan or barium enema are usually used to diagnose diverticular disease.

Possible complications

Although rare, serious complications may be life threatening and usually require emergency hospital treatment. Possible complications include bleeding from the bowel, a blockage (obstruction) of the colon, an abscess (collection of infection) in the abdomen, a channel (fistula) that may form between other organs such as the bladder, or a perforation (hole) in the wall of the bowel that can lead to infection inside the abdomen (peritonitis).

Treatment of diverticulitis

Treatment focuses on clearing up the infection and inflammation, relieving pain, resting the colon, and preventing or minimising complications. A small number of people with complicated disease (bowel perforation, abscess, fistula, multiple attacks, uncontrollable bleeding or peritonitis) may require emergency or elective surgery to remove the diseased segment of colon.

Bowel Polyps and Cancer of the Colon

Bowel polyps are small growths on the lining of the bowel wall. They are common, especially as we age. While most bowel polyps do not become cancerous, approximately 5% do. Most polyps can be safely and completely removed during a colonoscopy.

Approximately half of all Australians are likely to develop a bowel polyp during their lifetime, but the majority of these remain undetected. If polyps are left untreated for many years, a small percentage of polyps can develop into bowel cancer. Although polyps are very common, they rarely produce symptoms and usually are discovered by chance at the time of colonoscopy.

How are polyps detected and treated?

The detection of polyps and early bowel cancers can best be detected through a simple two minute poo test (called a Faecal Occult Blood Test (FOBT) and subsequent colonoscopy. These tests are currently the best way of preventing and reducing the rate of bowel cancer in Australia.

Colonoscopic removal of a polyp (polypectomy) occurs via a small wire loop, like a lasso, which is passed over the top of a polyp and then closed at its base to snare the polyp off.

Who is at risk of bowel cancer?

Both men and women are at risk of developing bowel cancer. In Australia, the lifetime risk of developing bowel cancer before the age of 75 years is around 1 in 19 for men and 1 in 28 for women. The risk is greater for people who:

  • Are aged 50 years and over – risk increases with age.
  • Have a significant family history of bowel cancer.
  • Have had an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.
  • Have previously had special types of polyps, called adenomas, in the bowel.

People at above average risk of bowel cancer should talk to their doctor about relevant screening options.

 

 

 

 

 

 

 

Mr John Treacy, General Surgery in Darwin
Darwin General Surgeon Mr John Treacy
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