Anal fissure is a tear or ulcer in the tissue lining of the anus. This is a common and painful condition that often resolves with conservative (non-surgical) management.
Anal fissure may be associated with other conditions which require further investigation.
Treatments include topical ointments and Botox injections designed to relax temporarily the anal sphincter muscles and allow the overlying tissues to heal.
Surgery can also be effective but is usually reserved for patients who have failed to respond to other types of treatment.
Anal fistula is an abnormal connection between the skin around the anus and the inner lining of the anal canal or rectum. This is a common condition that is usually triggered by an abscess (infected pus) formed in the tissue surrounding the anus (perianal abscess).
Not all perianal abscesses lead to anal fistula disease and anal fistula disease can be associated with other conditions which require further investigation.
Anal fistula disease can be treated with simple surgical techniques such as fistulotomy (where the fistula is opened and allowed to heal properly), but may also require more complex surgery and detailed investigation. Anal Fistulas which pass through the sphincter muscles of the anus are often treated in a staged way (ie more than one planned operation is required) to avoid damaging the underlying muscle. In some circumstances, the best option is to place a seton drain through the fistula to reduce the risk of further abscess formation and reduce the frequency and severity of infections.
To guide treatment MRI scans or examination of the anus under anaesthesia may be required.
An inguinal hernia (a type of groin hernia) is a hernia within an anatomical structure called the inguinal canal.
The inguinal canal is one of several points of weakness in an otherwise solid fibrous layer of the abdominal wall.
An inguinal hernia occurs when the contents of the abdomen (often a section of bowel or internal abdominal fat) push through the inguinal canal and usually presents with a lump that can be felt in the groin.
Inguinal hernias can cause symptoms but can also be symptomless and are sometimes only identified by imaging the abdomen/groin using a CT scanner or Ultrasound machine.
Inguinal hernias are the most common type of hernia and are more common in men than women. It is not always necessary to repair inguinal hernias and the option of conservative (non-surgical) management may form part of the discussion with your surgeon.
The decision to proceed with surgery will depend on hernia size, symptoms, gender considerations, co-morbidity (other medical conditions which a patient may have), and patient preferences.
Options for repair include open (an incision over the hernia), laparoscopic (key-hole), and robotic surgical techniques.
Abdominal wall hernias can arise in natural points of weakness in an otherwise solid fibrous layer of the abdominal wall such as the umbilicus (belly button).
They can also arise in scars caused by previous surgery (incisional hernia) or directly through the abdominal wall itself (epigastric and Spigelian hernias).
Abdominal wall hernias occur when the contents of the abdomen (often a section of bowel or internal abdominal fat) push through the point of weakness and usually present with a lump that can be felt beneath the skin.
Abdominal hernias can cause symptoms but can also be symptomless and are sometimes only identified by imaging the abdomen/groin using a CT scanner or Ultrasound machine.
It is not always necessary to repair abdominal wall hernias and the option of conservative (non-surgical) management may form part of the discussion with your surgeon.
The decision to proceed with surgery will depend on hernia size, symptoms, co-morbidity (other medical conditions which a patient may have), and patient preferences.
Options for repair include open (an incision over the hernia), laparoscopic (key-hole), and robotic surgical techniques.
A femoral hernia is a type of groin hernia within an anatomical structure called the femoral canal.
The femoral canal is one of several points of weakness in an otherwise solid fibrous layer of the abdominal wall.
Femoral hernia occurs when the contents of the abdomen (often a section of bowel or internal abdominal fat) push through the femoral canal and usually presents with a lump that can be felt in the groin.
Femoral hernias can cause symptoms but can also be symptomless and are sometimes only identified by imaging the abdomen/groin using a CT scanner or Ultrasound machine.
Femoral hernias are more common in women than in men. In most circumstances surgical management of femoral hernias is recommended to avoid potentially dangerous complications such as strangulation (where the blood supply to a section of the bowel is cut off causing a surgical emergency) and obstruction (where the bowel becomes blocked causing a surgical emergency).
Options for repair include open (an incision over the hernia), laparoscopic (key-hole), and robotic surgical techniques.
Haemorrhoids, also known as Piles are swellings caused by the enlargement of columns of blood vessels found just inside the anus.
Piles are very common and often cause no symptoms.
Treatment is considered if Piles become significantly enlarged and prolapse (hang down) from the anus or if they become symptomatic, causing bleeding, itchiness, mucous discharge, or occasionally severe pain.
Piles are easily diagnosed on examination, but other investigatory tests are often required to rule out alternative causes of symptoms. Symptoms may improve with simple measures aimed at avoiding constipation and straining to stool, but surgery can also be very effective if indicated. Surgical options range from simple banding procedures which can be performed in the clinic without the need for anaesthesia, to more advanced techniques in theatre such as haemorrhoidal artery ligation and haemorrhoidopexy (HALO or THD) and surgical excision of Piles (haemorrhoidectomy).
Treatment options are individually tailored and will depend on whether the haemorrohoids are internal (within the anal canal) or external (prolapsing out of the anal canal) and the degree of symptoms they cause.
Proctology is the treatment of conditions relating to the anus and rectum. For information relating to Piles (haemorrhoids), anal fissure and anal fistulae please refer to the appropriate section of this website.
I have broad training in all aspects of proctology including pruritis ani (perianal itching), perianal pain and the diagnosis of skin lesions around the anus as well as pilonidal sinus surgery. Colorectal cancer, Diverticular disease and Inflammatory bowel disease: My NHS practice is dedicated to the diagnosis and treatment of common bowel conditions including colorectal cancer, Inflammatory bowel disease (IBD; Crohn’s disease and Ulcerative colitis), and diverticular disease.
My main area of expertise is in the application of minimally invasive techniques which include laparoscopic (key-hole) and robotic surgery to treat these conditions.
Endoscopy (colonoscopy and flexible sigmoidoscopy) is a cornerstone of the diagnostic process and I have a wealth of expertise in this technique.
In advance of this procedure, a strong laxative is prescribed to clean the bowel, and a flexible camera (endoscope/colonoscope) is passed through the colon and rectum to screen for disease.
Endoscopy can also be used to treat small growths in the bowel called polyps, which can in some circumstances develop into more sinister pathology if left untreated.