What is abdominal pain?

Abdominal pain can be a symptom of many conditions. It is the name given to pain that radiates between the chest and the groin. The most common cause is: constipation, irritable bowel syndrome, food allergies or intolerances, or food poisoning. There are different types of abdominal pain, including: 

• Burning pain: could be caused by gastritis, an ulcer, or reflux.
• Colic pain: could be due to intestinal issues such as diarrhoea or constipation. For females it could be due to menstrual problems and the pain may be located around the uterus.
• Stitches: caused by excess gases or abdominal swelling. 

Condition prognosis         

Condition prognosis depends of the cause of the abdominal pain. The causes may range from simple issues such as excess gas to more complicated conditions such as appendicitis or kidney stones. When a person has abdominal pain, the cause of it must be looked at thoroughly to be able to properly treat it. There are some symptoms which may be a sign of a more serious condition, such as:

• Having a temperature above 38 ºC
• Vomiting
• Blood in the stools
• Sudden weight loss 
• Apathy or pallor.

What are the symptoms?

Different symptoms may indicate what is causing the abdominal pain. It may simply be due to indigestion, however when the pain is strong, it may be due to a more serious issue with the appendix, the gallbladder, the pancreas, or the kidneys among others.  

Medical tests

Different tests can be carried out to determine the cause of abdominal pain:

• Colonoscopy 
• Abdominal ultrasound
• Endoscopy
• Abdominal CT scan
• Blood test.

What causes it?

There could be many causes for abdominal pain, it is important to find the cause and seek medical attention as soon as possible. The most common causes for abdominal pain include:

• Irritable bowel syndrome
• Allergies or intolerances
• Food poisoning
• Gastroenteritis
• Constipation
• Appendicitis
• Bowel block
• Diverticulitis
• Ulcers.  

How can it be prevented?

Abdominal pain can be prevented by following a healthy and balanced diet, and eating small meals often. This will help digestion. It is also important to maintain a healthy weight and to exercise regularly. Stress in known as a cause of cramps and nausea.  

What is the treatment?    

Treatment will depend on the cause and location of the pain. The specialist will recommend what treatment should be used after careful examination. Treatment to treat mild causes include:

• Antacids if the pain is due to indigestion or reflux.
• Antiflatulents to relieve pain caused by gas or diarrhoea.
• Antibiotics used to treat infections. 

What specialist should I see?

Generally, the specialist who treats abdominal pain is a gastroenterologist. Digestive system specialists study the digestive tract including the oesophagus, stomach, small intestine, colon, rectum, anus, as well as the liver, gallbladder, and pancreas. This specialty treats common issues and pathological issues. It treat conditions that may affect other parts of the body and other organs.           

What is an anal abscess?

An anal abscess is an infected, pus-filled cavity near the anus, often appearing as a painful, boil-like swelling. They are most commonly small anal glands that have become infected.

What are the symptoms of an anal abscess?

Superficial anal abscesses usually cause one or more of the following symptoms:

• Constant, throbbing pain, which is accentuated during bowel movements or when sitting down
• Irritated skin around the anus, including redness, tenderness and swelling
• Discharge of pus
• Constipation

Deeper abscesses may cause further symptoms, such as:

• Tiredness
• Fever
• Chills
• Night sweats
• Malaise

Causes of anal abscesses

There are different causes of anal abscess:

• Blocked anal glands
• An infected anal fissure (tear in the anal canal)
• Sexually transmitted infections

In addition, there are certain factors that can increase the risk of anal abscess:

• Anal sex (receptive partner)
• Chemotherapy medication
• Diabetes
• Diverticulitis
• Inflammatory bowel disease, e.g. Crohn's disease, ulcerative colitis
• Corticosteroid medications
• Weak immune system

Can anal abscesses be prevented?

Some of the causes, such as diabetes and Crohn’s disease are difficult or impossible to prevent. However, one can take precautions to minimise the risk of developing anal abscesses, such as using a condom during anal sex or getting any soreness of the anal area checked out immediately, so that blocked anal glands or anal fissures can be identified and treated before they become infected.

In the case of infants and young children, frequent nappy changes and cleaning the child’s anal area properly can help prevent anal abscess and fistulas.

What is the treatment for an anal abscess?

An anal abscess will not disappear on its own, so the patient must see a doctor to drain the abscess. The patient usually goes home on the same day of the procedure, although larger abscesses may require hospitalisation and the assistance of an anaesthesiologist.

The doctor may prescribe pain medication for after the procedure. Patients with certain conditions like diabetes or a weak immune system may also be given antibiotics. Patients are advised to bathe the area with warm water e.g. in a bath three or four times a day.

Either at the same time as the abscess is drained or in the weeks following the procedure, the patient may also need fistula surgery to repair the hole or tunnel left behind once the abscess is drained.

What is an anal fissure?
An anal fissure (fissures) is a tear or crack in the lining of the anal canal (anus), which causes extreme pain during bowel movements. Anal fissures affect everyone, from men and women to young and old people. It is the most common cause of rectal bleeding in infancy. A fissure tends to occur when passing hard or large stools during a bowel movement. There may also be spasms in the ring of muscle at the end of the anus.

What is the cause of an anal fissure?
Common causes of an anal fissure include passing large stools, constipation and straining during bowel movements, chronic diarrhoea, inflammation of the anorectal area and childbirth. The less common causes of anal fissures include anal cancer, HIV, tuberculosis, syphilis and herpes.

What are the symptoms of an anal fissure?
The symptoms of an anal fissure include:

• Pain, which can sometimes be severe during bowel movements
• Pain after bowel movements
• Blood on the stool or toilet paper
• Itching or irritation around the anus
• A visible crack in the skin around the anus
• A small lump on the skin near the anal fissure

How is an anal fissure treated?
An anal fissure will often heal within a few weeks if the stool is kept soft through increasing the intake of fibre and fluids. Soaking in a warm bath for 10 to 20 minutes daily, especially after toilet use, helps to relax the sphincter and helps it to heal. A doctor may recommend topical anaesthetic creams for pain relief. A Botox (Botulinum toxic type A) injection can paralyse the anal sphincter muscle and aids in relaxing spasms. Blood pressure medications can also help relax the sphincter.

How to prevent an anal fissure?
By preventing constipation it may help in preventing an anal fissure. Constipation can be prevented when eating high-fibre foods, drinking water and regularly exercising to stop from straining during bowel movements.

Risk factors for developing an anal fissure

• Infancy – experts are not sure why but many infants experience an anal fissure during the first year of their life.
• Aging – as an adult ages there is a decrease in circulation and blood flow to the rectal area.
• Constipation – straining when trying to pass hard stool can increase the risk of tearing.
• Childbirth – anal fissures become common in women after they give birth.
• Crohn’s disease – the inflammatory bowel disease causes chronic inflammation of the intestinal tract and this makes the lining of the rectum vulnerable to tearing.
• Anal intercourse.  

What is an anal fistula?

An anal fistula is small channel or tunnel that develops between the end of the bowel and the skin near the anus (i.e. where stool leaves the body). These can result in bleeding when passing stool and cause pain and discomfort. Often anal fistulas won’t get better on their own and will usually require treatment. Surgery is a common recommendation for treating anal fistulas.

What are the symptoms of an anal fistula?

The most common symptoms of an anal fistula are:

• pain where the fistula is, which can be made worse when sitting down or passing stool
• passing pus or blood 
• skin irritation around the anus
• fever

What causes an anal fistula?

Anal fistulas are usually a result of an anal abscess that has not healed properly. When an anal abscess has not healed properly, the pus has drained away, but leaves a channel or tunnel behind. It is common for an anal abscess to result in anal fistula.

Other causes of anal fistulas include:

• surgical complication near the anus
• Crohn’s disease
• diverticulitis

What is the treatment for an anal fistula?

As anal fistulas usually do not heal on their own, surgery is often required. There are numerous types of surgery, including:

• Fistulotomy – the length of the fistula is cut open so that the contents can be removed. Once healed, a flat scar is left behind.
• Seton procedures – surgical thread (a seton) is placed into the fistula and left there for a few weeks. This helps it to heal before another procedure is performed to treat it fully.
• Fibrin glue – a non-surgical treatment option that involves glue being injected into the fistula to seal the channel, with the opening stitched shut. However, long-term results with this procedure are not as successful with further surgery being required in many cases.
• Flap procedures – often used in more complex cases, a piece or flap of tissue from skin around the anus is removed. The fistula tract is also removed and the flap if reattached where the fistula opening was.

What is anal fistula surgery?

An anal fistula is a tunnel or channel that develops between the skin near the anus and the bowel. This can have a number of unpleasant symptoms, and surgery, known as anal fistula surgery, is often undertaken to correct this. It is performed under general anaesthetic.

Why would you do it?

Anal fistula surgery is usually needed to treat anyone suffering from an anal fistula as they are unlikely to heal on their own. Anal fistulas are normally the result of an abscess around the anus, which when drained of the pus, leaves a small channel behind it.

Anal fistulas can be extremely unpleasant, and often cause discomfort. Surgery is nearly always required.

What does it involve?

Anal fistula surgery is carried out under general anaesthetic. There is more than one possible procedure and the most suitable will depend on individual cases.

Fistulotomy:

• A fistulotomy involves cutting the fistula open and allowing it to heal as a flat scar. This is the most common form of surgery.
• This is the best choice of treatment for fistulas that don’t pass through the sphincter.
• If the anal fistula does pass through the sphincter, then there is an increased risk of incontinence with a fistulotomy and other procedures might be preferred.

Seton techniques:

• A seton is a piece of surgical thread that can be inserted into the fistula to keep it open.
• This can be deployed to keep the fistula open for several weeks, allowing it time to drain and heal thus avoiding the need to make an incision.
• Although this allows the fistula to heal, it does not cure it. To cure the fistula, it may be necessary to have numerous, tighter setons inserted to gradually cut through the fistula.

Advancement flap procedure:

• This involves covering the entrance of the fistula to the bowel with a flap of tissue from the rectum.
• This procedure means that the muscles around the anal sphincter do not need to be cut.

How to prepare for it

Leading up to the surgery, it might be necessary to stop taking certain medications. It is also likely that you will need to empty your colon with either a laxative or an enema before surgery. You will also need to stop eating and drinking a certain period prior to surgery. It is recommended that you have someone to drive you home after surgery.

Post-operative care

It is to be expected that there will be some bleeding and pain with your first bowel movement after surgery. It can help to make this less painful by adopting a high-fibre diet and taking stool-softeners the first few days after surgery.

Most patients will return to normal activities 1 to 2 weeks after surgery, but it will taken several weeks or a few months for the fistula to fully heal, depending on the individual case.

Here are some key post-operative care things to do after having anal fistula surgery:

• Keep active – try to walk a little each day.
• Diet – eat a high-fibre diet daily.
• Stay hydrated
• Painkillers may be prescribed for the first couple of weeks.
• Keep the area operated on clean – warm baths are recommended.

What is appendicitis?

Appendicitis is an inflammation of the appendix, which is a small pouch of tissue attached to the colon, located in the lower right abdomen. It is formed at the junction of the small and large intestines.

What are the symptoms?

A sudden pain around the middle of the abdomen that moves to the lower right abdomen or a pain in the lower right abdomen (where the appendix is located) are common symptoms of appendicitis.  Other symptoms include nausea, vomiting, loss of appetite, diarrhoea and a fever. A pain that becomes worse all of a sudden and spreads across the abdomen is a sign that the appendix may have burst and requires immediate medical attention.

What causes appendicitis?

Appendicitis is caused by a blockage or obstruction in the appendix that leads to infection. The appendix gets filled with a build-up of mucus, causing swelling.

How can it be prevented?

Appendicitis is very hard to prevent, although there is evidence that it is less prevalent in people with high fibre diets.

Appendicitis can lead to the appendix rupturing, which is a very dangerous complication and it is important to prevent the condition reaching this stage.

A ruptured appendix spreads potentially life-threatening infection. Peritonitis occurs when the peritoneum (tissue which lines the abdomen) becomes infected and can cause long-term problem and even death.

What is the treatment?

In most cases, the appendix is removed by surgery. The operation is referred to as an appendectomy and is performed to prevent the appendix from bursting. The operation is performed as either open or keyhole surgery.

Keyhole surgery is preferred over open surgery and will be carried out where possible. Keyhole, or laparoscopic, surgery is less invasive than open surgery and has shorter recovery times.  Several small incisions are made in the abdomen, which is then inflated with a gas to make it easier to perform the surgery. The operation is done with the aid of a laparoscope, which is a small tube with a camera that relays images back to the surgeon.

In cases where the patient has previously had abdominal surgery or the appendix has already burst in might not be possible to perform keyhole surgery. In these cases, open surgery might be preformed, which consists of a single, much larger cut in the lower right abdomen.

If the appendix has burst and an abscess has formed, it will be necessary to drain the abscess before performing an appendectomy. 

What is it?

Bowel cancer, also known as colorectal cancer, originates from the development of tumour cells in the mucosa of the bowel. Given that the colon and the rectum are connected, the cancer often develops in one area and spreads to the other: that is why it is also called colorectal cancer.

It has been estimated that this type of cancer is the third largest cause of death in developed countries, and is more common in men than in women. Even though it is a fairly widespread cancer, if detected early survival rate is around 80%.

What are the symptoms?

The main symptoms of colorectal cancer include:

• a sudden and persistent change in your bowel habit
• persistent blood in the stool
• unexpected weight loss
• general fatigue
• anaemia
• lumps in the abdominal area

However, these symptoms can be very mild and can be confused with symptoms for other conditions. That is why you should always pay attention to possible signs such as fatigue (asthenia), loss of appetite and anaemia.

How is it diagnosed?

This condition can be diagnosed with exams such as colonoscopy, sigmoidoscopy, or a colorectal X-ray scan.

What causes it?

One of the main causes of colorectal cancer is genetic predisposition. If there’s a family history of cancer or polyps, your possibility of getting this cancer increases by as much as four times.

An unhealthy diet and a sedentary lifestyle can also lead to developing this type of cancer. The same goes for smoking and excessive alcohol consumption. Finally, chronic inflammatory disease of the bowel can also increase your risk of getting colorectal cancer.

How can it be prevented?

You cannot completely prevent bowel cancer but you can take steps to reduce your risk. According to the latest research, some foods and drink may increase your chances of getting bowel cancer. These include: red meat, processed meat and alcohol. Being overweight or obese can also lead to bowel cancer. On the other hand, an active lifestyle and eating a diet rich in fibre, garlic and milk seems to have a positive effect on bowel health.

How can it be treated?

If detected early (when the cancer is still restricted to one area), the most effective treatment consists in surgically removing the tumour cells. If your doctor thinks there may be further tumour lesions, after surgery you may get started on chemotherapy. If the cancer is already in its more advanced stages, treatment will be more complex, possibly involving radiotherapy and/or further chemotherapy sessions.

Which doctor should I talk to?

For screening exams, you should see a gastroenterologist. Should you be diagnosed with colorectal cancer, you will need to see an oncologist and a general surgeon.

What is a colectomy?

Colectomy is a surgical procedure that involves the removal of all, or the partial sectioning, of the large intestine (colon). The colon is a long tube-shaped organ at the end of the digestive tract. A colectomy is necessary to treat or prevent diseases and conditions that affect the colon.

Diseases and conditions treated with a total or partial colectomy

The following conditions may require a colectomy:

• Bowel obstruction – when the colon is blocked.
• Bowel perforation – a torn colon, or where bleeding cannot be controlled.
• Crohn’s disease – removing the affected part of the colon.
• Colon cancer – early-stage cancers may need a small section of the colon to be removed, whilst cancers at a later stage may require more to be removed.
• Lynch Syndrome
• Precancerous colon polyps – those with a high-risk of developing cancer.
• Ulcerative colitis – a colectomy is required if medications are not working.

Different types of colectomy operations

A total colectomy removes the entire large intestine. A partial colectomy, also known as a subtotal colectomy, removes only part of the colon. A hemicolectomy removes either the right or the left portion of the colon and a proctolectomy removes both the colon and the rectum.

Open vs. laparoscopic procedure for colectomy

During an open colectomy, a long incision is made in the wall of the abdomen and doctors can see the colon. In a laparoscopic-assisted colectomy, a lighted tube with a video camera is in inserted through one of several small incisions to guide the surgery.

Risks of a colectomy

The procedure carries a risk of serious complications, which depend on the patients' general health and the type of colectomy used to perform the operation. These complications can include:

• Bleeding
• Deep vein thrombosis (blood clots in the leg)
• Infection
• Injury to organs near your colon, such as the bladder and small intestines
• Pulmonary embolism (blood clots in the lungs)
• Tears in the sutures that reconnect the digestive system.

How to prepare for a colectomy

In the days leading up to the colectomy, the doctor will suggest that the patient stops taking certain medications. Fasting before surgery is also required and drinking a solution such as a laxative that clears your bowels. In some cases, a doctor may prescribe antibiotics to prevent any infection from occurring.

Cholecystectomy is the surgical removal of the gallbladder as a treatment for gallstones or other gallbladder problems.

What is cholelithiasis?

Cholelithiasis refers to the presence of one or more gallstones in the gallbladder. Gallstones are little stones made of cholesterol formed in the gallbladder. The gallbladder is a small organ found underneath the liver and aids digestion by releasing a digestive fluid called bile into the small intestine.

What are the symptoms of cholelithiasis?

Most of time gallstones do not cause any symptoms and do not require treatment, however, if a gallstone happens to get trapped in a duct inside the gallbladder, it can cause the following symptoms:

• Intense and constant abdominal pain (called biliary colic)
• Pain between your shoulders
• Nausea and/or vomiting

Sometimes cholelithiasis can be more serious, especially if the gallstone blocks the flow of bile, and the following symptoms can be triggered:

• Fever
• More intense pain
• Diarrhoea
• Jaundice
• No appetite

What causes cholelithiasis?

Although causes of gallstones are not totally clear, they are thought to occur when there is an imbalance in the make-up of the bile inside the gallbladder. Such imbalances are thought to occur when:

• High levels of cholesterol are found in the gallbladder, meaning there is not enough bile to digest the amount of cholesterol in the gallbladder. The excess cholesterol then forms into gallstones.
• High levels of bilirubin are found in the gallbladder. Bilirubin is a waste product made when red blood cells are broken down. Excess bilirubin contribute to the formation of gallstones.

How can cholelithiasis be prevented?

Research indicates that weight-loss and diet can help to prevent gallstones developing.

A healthy, low-saturated fat diet is recommended. This is helps to reduce the intake of bad cholesterol which can cause gallstones to form. Also recommended, is avoiding the consumption of large amounts of alcohol.

Being overweight is also a risk-factor for developing gallstones. Therefore, maintaining a healthy weight by eating healthily and exercising regularly is highly recommended. Losing weight via low-calorie diets are not recommended however, as they have been linked to disrupting bile production, and can therefore increase chances of gallstones developing.

What is the treatment for cholelithiasis?

If your gallstones do not cause symptoms, then most likely you will not need treatment, but will be recommended to actively monitor your condition, and to return to a specialist if symptoms occur. However, those who do experience symptoms will likely have the following treatment options:

• Gallbladder removal surgery (cholecystectomy) – gallstones can reoccur, so removing the gallbladder entirely is one way to ensure that gallstones do not recur. After it is removed, bile goes straight from the liver in to the small intestine.
• Medications – there are certain medications designed to dissolve gallstones and are taken orally. These need to be taken over a long period of time and are not always effective.

Colon cancer is the proliferation of malignant cells in the colon, which, along with the rectum, is in charge of storing faeces which are then expelled through the anus. Its causes are determined by genetics, sedentary lifestyle and previous illnesses such as polyps, ulcerative colitis and other cancers. The most obvious symptoms of the disease become visible when the disease is advanced: alternating between diarrhoea and constipation, blood in the stool, abdominal pain, loss of appetite, weight loss and fatigue. If detected early there is a good chance of cure, with the most common treatments being radiotherapy, chemotherapy, immunotherapy to strengthen the body's defences, and surgery.

Colorectal cancer begins with a polyp that develops in the colon or rectum. When this polyp is covered with adipose tissue it can change into an adenoma, a specific type of polyp, or adenocarcinoma, a type of cancer that contains mucus and other fluids. The tests to detect colon cancer are usually carried out through colonoscopy, a test that introduces a thin and flexible tube with a camera (endoscope) into the anus, and virtual colonoscopy, a radiological examination that obtains images. The purpose of these tests is to determine the presence of adenomas and polyps in the colon and to surgically remove them before they become cancerous.

What is colorectal cancer surgery?

Colorectal cancer, also known as bowel cancer, is the cancer of the large intestine (colon). The large intestine makes up the end of the digestive tract, and cancer usually starts as a cluster of cells called polyps. Not all polyps are cancerous, and therefore it is important to closely monitor them and have them removed before they become cancerous.

Colorectal cancer surgery involves the removal of the cancerous part of the colon, which is known as a colectomy. Depending on what stage the cancer is at, surgery can range from minimally-invasive polyp removal, to the removal of both the colon and rectum. Depending on the type of surgery, local or general anaesthetic will be used.

If colorectal cancer is identified early on, surgical treatment can often cure the cancer and prevent it from returning, however, this is not always possible. Surgery is often combined with other treatments such as chemotherapy and radiotherapy.

What causes colorectal cancer?

Exact causes of colorectal cancer are unknown, however, there are associated risk factors that can increase the likelihood of developing it. These include:

• Age – people over the age of 60 are more likely to be diagnosed with colorectal cancer.
• Family history – if a direct relative has had colorectal cancer, chances of developing colorectal cancer are increased.
• Smoking & alcohol
• Diet – evidence has suggested that diets containing large portions of red meat have an increased chance of colorectal cancer developing.
• Obesity
• Digestive disorders – people suffering chronically from disorders such as Crohn’s disease are more likely to suffer from colorectal cancer.
• Genetic conditions – there are genetic syndromes that increase the number of polyps formed, increasing the chance of these polyps becoming cancerous over time. These syndromes are called familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC).

What does surgery involve?

Surgery for early-stage colorectal cancer usually involves the removal of a small section of the colon lining. This is called a local excision.

However, if the cancer has spread into the surrounding muscle, a whole section of the colon will need to be removed. This is called a colectomy. Colectomies can be carried out in the following ways:

• Laparoscopically – a special instrument is guided by cameras through small incisions in the abdomen.
• Robotically – keyhole surgery carried out by a special robotic instrument.
• Open surgery – a large incision is made in the abdomen so that part of the colon can be removed.

Whilst surgery is carried out, it is common for nearby lymph nodes to be removed as well and will be tested for cancer. During a colectomy, the surgeon will reconnect the healthy parts of the colon. If these cannot be reconnected, then the surgeon will have to carry out stoma surgery. This diverts the faeces away from the colon towards an opening in the abdomen and into a stool bag that is fitted to the opening. The stoma will either be temporary or permanent, depending on how well the colon heals after surgery.

How to prepare for surgery

Depending on the type of surgery, you might be required to a follow a special diet before surgery, or to empty your bowels. On the day of surgery, you won’t be able to eat or drink. It is common that prior to surgery you will be given a dose of antibiotics to prevent the possibility of infection.

If you are going to have a stoma, then you will have met a stoma specialist to explain how they work.

Post-operative care

Immediately after surgery, the care team will try to get you moving to prevent blood clotting. It is common to expect some pain and nausea. Patients can generally return home in around three to seven days after surgery, and a check-up appointment would be booked in to discuss recovery and any further treatment required.

What is Crohn’s disease?

Crohn’s disease is a type of chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract from mouth to anus, but is most commonly found at the end of the small intestine, where this meets the colon (large intestine). It is characterised by inflammation, which is often severe and can be debilitating, and may extend through the whole width of the bowel wall.

Prognosis of Crohn’s disease

Crohn’s is a chronic condition, meaning long-term. There is currently no known cure for Crohn’s disease, although existing therapies make it manageable and can cause the disease to go into remission for years at a time. Flare-ups still occur periodically, however, and can make life difficult.

Symptoms of Crohn’s disease

When Crohn’s disease is active, typical symptoms include:

• Diarrhoea
• Abdominal pain (stomach aches, etc.)
• Blood in the stool
• Fatigue
• Weight loss
• Reduced appetite
• Mouth sores
• Fever

Symptoms can range from mild to severe, and usually develop gradually, but may come on in sudden attacks.

In severe cases, Crohn’s can also affect other parts of the body, including inflammation in the joints, the liver, the skin, and the eyes.

Crohn’s can start at any age, but symptoms usually first manifest in late childhood and early adulthood, with the majority of cases being diagnosed before the age of 30.

It often occurs in flare-ups, which may go into remission with treatment, but will flare up again weeks, months, or even years later.

What are the causes of Crohn’s disease?

The causes of Crohn’s disease are currently poorly understood, but a great deal of research into the illness is being carried across the world and experts are continuing to learn a lot about its mechanisms and possible causes. The leading theories are that it is caused by a combination of some of the following factors:

• Genetics – it is thought that some people are born with genes that predispose them to the development of Crohn’s
• Autoimmune – many experts believe that Crohn’s is an autoimmune disease; that is, the immune system mistakenly attacks cells in the digestive system as if they were invading bacteria or viruses.
• Gut bacteria and antigens – it is possible that certain bacteria or the antigens they produce may trigger the autoimmune response. Another theory is that an imbalance in gut bacteria may have a more direct effect on the development of Crohn’s. Current research indicates that, whatever the mechanism, bacteria seem to be relevant.

Other risk factors that may contribute include:

• Smoking
• Previous stomach bugs
• Living in an urban environment
• Family history, i.e. relatives that also have Crohn’s

Treatments for Crohn’s disease

While Crohn’s disease cannot be cured, there are treatments to reduce and control the symptoms. Sometimes, these treatments can be enough to send the disease into periods of remission. Typical treatment options include:

• Various anti-inflammatory medication, including certain steroids. The type prescribed will depend on the patient and on the severity and location of the inflammation in the digestive system.
• Immune system suppressors may be prescribed to reduce inflammation by targeting the immune system, which makes the substances that cause inflammation.
• Surgery may be the best option – by removing part of the tissue in the digestive tract, and reconnecting the healthy sections, the inflammation can be removed. However, this does not eliminate the chances of recurrence; surgery usually offers a temporary solution in severe cases of the disease.

Which type of specialist treats Crohn’s disease?

Gastroenterologists treat all kinds of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis. Colorectal surgeons are usually responsible for performing operations to treat IBD.

Diverticular disease is characterized by the presence of diverticula in the colon wall, due to an increase in intraluminal pressure. Diverticula are pockets that usually form on the left side of the colon walls, although it can occupy the entire colon. When an increase in intraluminal pressure produces a pulse of the muscosa occurs through colonic muscle layers in their weak points, which correspond to the points where the neurovascular bundles penetrate. In most cases, diverticular disease have no symptoms, and only when there is bleeding or complications may appear diverticulitis. Diverticulitis (that is infection of the diverticula) in turn can cause abdominal pain, fever and chills. More serious complications can even cause an ruputura or fistulae that require surgery. The treatment of diverticular disease is essential and based on regular consumption of dietary fiber. In the case of diverticulitis, treatment should be done by antibiotics (oral or intravenous), restrictions on food and stool softeners.

What is diverticulitis?

Diverticulitis is a condition affecting the large intestine, or bowel. It is closely related to another condition affecting the bowel, called diverticular disease. Diverticulitis is more likely to occur in those who do not get enough fibre through their diet.  

What causes diverticulitis?

As we get older, small pockets or bulges called diverticula may develop in the lining of the intestine. These do not often cause symptoms and can go entirely unnoticed, but when they do cause symptoms, this is referred to as diverticular disease. Once symptoms become more severe, and the diverticula become infected, or inflamed, this is referred to as diverticulitis.

What are the symptoms of diverticulitis?

Diverticulitis symptoms include:

• Severe, constant tummy pain
• Feeling sick/vomiting
• Fatigue (feeling tired)
• Blood in your stool
• Rectal bleeding
• A high temperature (over 38 degrees Celsius)

If you experience symptoms of diverticulitis, without any previous diagnosis of diverticular disease, you should contact your GP as soon as possible. If you have a previous diagnosis of diverticular disease the symptoms can be managed and treated from home. However, if you notice bleeding, or are experiencing severe pain, it is best to seek medical attention.

How is diverticulitis diagnosed?

Your doctor will take your medical history and make an assessment of your symptoms. This is because they will want to rule out other conditions which can display similar symptoms, such as IBS (irritable bowel syndrome), or bowel cancer.

The doctor may also take blood tests and refer you for a colonoscopy or CT scan.

What is the treatment for diverticulitis?

Diverticulitis is most commonly treated at home using medication to relieve symptoms of pain, and antibiotics. In more severe cases, diverticulitis can be treated at the hospital so the doctor can monitor your progress and symptoms. Treatment in hospital may involve antibiotics administered through injections, and an intravenous drip to provide hydration and nourishment.

If you have already been diagnosed with diverticular disease, a high-fibre diet may help to ease any symptoms you experience with the condition. The ideal amount of fibre for an adult is 30g per day, and your doctor will discuss targets and ways to include fibre in your diet.

In more extreme cases, diverticulitis can be treated with surgery. This type of treatment is rare, and it involves removing the affected section of intestine. However, before any type of surgery, your surgeon will discuss the benefits and risks implied.

What is an epigastric hernia?

An epigastric hernia is when fat or body tissue protrudes through the abdominal wall, between the sternum of your rib cage and your belly button. Often there are no symptoms with this type of hernia and they often go unnoticed. This type of hernia is usually small and you can have more than one at a time. Despite showing few symptoms, they can sometimes cause pain in the upper abdominal region. 

What are the symptoms of an epigastric hernia?

Although symptoms with an epigastric hernia are uncommon, a noticeable bulge might present especially when you cough, sneeze, laugh or strain. Sometimes this type of hernia can cause pain and tenderness in the affected area. 

What causes an epigastric hernia?

This type of hernia is usually present from birth due to incomplete abdominal wall development. 

What is the treatment for an epigastric hernia?

These hernias do not heal themselves and surgery is required to repair them.  However, unless the hernia becomes an emergency surgery can be delayed until the patient feels ready, or when a child becomes older. Often when adults are diagnosed with an epigastric hernia, it has become problematic due to obesity, muscle weakness or frequent strain on the abdominal wall due to heavy lifting or straining. 

Surgery can be peformed either openly, or laparoscopically. General anaesthesia is used. If the defected muscle opening is small then sutures usually suffice to close the hole. However, for larger muscular defects, an inserted mesh might be needed to restore strength to the abdominal wall. Such a mesh is permanent and stops the hernia from returning. 

Most patients are able to return to their normal activities within two to four weeks following surgery. 

What is a femoral hernia?

A femoral hernia is fairly uncommon and is most commonly found in women. Femoral hernias are found in the groin region and can appear as a painful lump on the inner, upper thigh. The lump can be pushed back in and can sometimes become more prominent when straining or coughing. It is estimated that only 1 in 20 groin hernias are femoral hernias, and are mostly inguinal hernias. They are more common in women because women have a wider pelvis. 

What are the symptoms of a femoral hernia?

Some people with a femoral hernia do not notice any bulge, lump or pain, however, larger femoral hernias produce a visible bulge in your upper thigh which can be painful, especially when straining.

What causes a femoral hernia?

A femoral hernia is the result of fatty tissue or a section of the bowel protruding through into the groin on the top of your inner thigh. The section where the protrusion can occur is called the femoral canal and is considered a weak spot in the abdominal wall muscles. The actual causes of a femoral hernia are:

• heavy-lifting
• straining on the toilet
• obesity
• a persistent, heavy cough
• childbirth

What is the treatment for a femoral hernia?

Unlike other types of hernia, femoral hernias usually require treatment straight away due to potential complications associated with them. Surgery can be performed to put the bulge back into place and to fix the weakened abdominal wall. Complications that can result from femoral hernias include:

Obstruction where part of the bowel can become stuck in the femoral canal resulting in nausea and pain.
Strangulation where the stuck section of bowel has its blood supply cut off (ischaemia), which required immediate surgical attention so that blood supply is restored and the tissue doesn’t die.

Surgery for treating femoral hernias can either be open surgery, or it can be performed laparoscopically. Patients can usually return home either the same day or the following day. 

What is gallbladder surgery?

Gallbladder surgery is a surgical procedure that is performed to remove the gallbladder, an organ located in the lower part of the liver that serves as a reserve for bile.

Why is gallbladder surgery performed?

Gallbladder surgery is performed when the patient is experiencing pain or presenting with symptoms caused by the formation of calculi (stones) in the gallbladder.

What does gallbladder surgery consist of?

The intervention can be minimally-invasive or open. In the first case the surgeon will make three or four incisions in the abdomen and through one of the holes will introduce a laparoscope (thin and illuminated tube connected to a camera that allows the surgeon to see the inside the cavity) and other instruments necessary to perform the procedure.

Subsequently, the specialist will insert gas with a needle to expand the abdomen and cut the bile duct and blood vessels leading to the gallbladder. Finally, the gallbladder is removed.

When gallstones are more severe or there are complications during surgery, an open operation is carried out. This involves making a small cut in the abdomen to open it and extracting the gallbladder through the incision.

Preparation for gallbladder surgery

Before gallbladder surgery, you must undergo certain tests, such as blood tests, urine tests, or certain types of scan (e.g ultrasound) so the specialist can assess your health status, and determine if you are suitable for surgery.

Care after gallbladder surgery

Recovery after gallbladder surgery will depend on the surgical technique used. Normally, in the case of performing an open surgery, 2-4 days recuperation in the hospital is recommended, and in the case of minimally-invasive surgery, day-case procedures can be performed, or an overnight stay may be recommended.

After you are discharged from hospital, postoperative recovery at home e.g resting and avoiding strenuous activity is necessary. Follow your surgeon’s instructions as recovery time depends on the type of procedure performed. You will also be advised how to clean your wound, and how to change dressings if necessary.

What are gallstones?

Gallstones are hard lumps or stones, usually made of cholesterol or sometimes other substances like bilirubin that form in the gallbladder.  

The gallbladder is a small organ situation underneath the liver which releases bile (produced by the liver but stored and concentrated in the gallbladder) into the digestive system to help the body breakdown fats into fatty acids for absorption.

What are the symptoms?

Gallstones don’t always produce symptoms and do not always need treating. In fact, the vast majority of people will not experience symptoms as the gallstones themselves do not cause pain.

In certain circumstances however, a gallstone might become trapped, causing intense pain known as biliary colic. The pain usually starts in the upper right part of the abdomen and radiates to the shoulder.

Further complications can arise whereby the gallbladder becomes inflamed - symptoms can include jaundice (a yellowing of the eyes and skin), fever, persistent pain, nausea and vomiting.

What causes gallstones?

The development of gallstones is thought to be due to too much cholesterol or bilirubin in the bile, leading to the formation of stones. In the majority of cases gallstones are made of cholesterol, however if the liver is producing too much bilirubin (often due to damage) this can result in the formation of stones also.

Improper emptying of the gallbladder is also thought to cause stones, as the bile becomes too concentrated.

How can gallstones be prevented?

Risk factors for the development of gallstones include being overweight, a lack of exercise, a diet containing too much cholesterol and fat that is also low in fibre, and rapid weight loss. It stands to reason therefore that maintaining a balanced diet and a healthy weight can help to prevent the development of gallstones.  Other risk factors for the disease include liver problems and diabetes.

What is the treatment?

Gallstones don’t always need treatment and in many cases the best option is to monitor them and only treat them if symptoms appear. If, however they are causing complications it might be necessary to treat them immediatley. Additionally, patients who have conditions which increase the risk of complications, such as portal hypertension (high blood pressure in the liver), cirrhosis of the liver or diabetes may need more urgent treatment.

In most cases, keyhole surgery is performed to remove the gallbladder, in an operation known as a cholecystectomy. Following the operation, patients can lead a normal life without the gallbladder as the liver will continue to produce bile. 

What is a gastric sleeve?

Gastric sleeve (or sleeve gastrectomy) is a restrictive weight loss surgical procedure, where the capacity of the stomach is dramatically reduced by about 75% to aid in long-term weight loss. The procedure is called gastric sleeve as the surgeon removes part of the stomach and joins the remainder together, which resembles a ‘sleeve’ and is the size of a banana. A reduction in stomach size makes it difficult for a patient to overeat. The surgeon also removes the part of the stomach that produces the hunger hormone ghrelin, which is known to boost appetite.
 

Why is a gastric sleeve operation performed?

A gastric sleeve is an option for patients who are obese, with a body mass index (BMI) greater than 50 and who have not managed to lose the necessary weight through other methods such as a healthy diet and exercise.
 

What does it consist of?

Sleeve gastrectomy intervention is done by laparoscopy that usually lasts between 60 to 90 minutes. The surgeon will make a few small cuts, between 2 and 5 incisions, in the abdomen through which the laparoscope (an instrument with a tiny camera that sends pictures to a monitor) will be introduced. This enables the surgeon to see the inside of the abdomen during the operation. Then the removal of most of the stomach will be carried out, leaving a vertical tube shape, which is an irreversible procedure.
 

How do I prepare for a gastric sleeve?

Before having a gastric sleeve operation the patient should undergo various tests, such as a complete physical examination, blood tests and an ultrasound of the gallbladder to confirm that they are healthy enough to have weight loss surgery. There are essential steps that a patient must take to prepare for bariatric surgery, including a lot of lifestyle changes.

It is recommended to quit smoking as the use of tobacco products have been proven to increase the risk of complications during and after surgery. Changes to diet, such as eating three regular meals a day with two small snacks per day, is a good way to prepare the body for the routine following surgery. Most doctors require a special pre-operation diet.

Patients are advised to drink more water and limit other beverages. They should incorporate physical activity into their everyday lives and start with a small exercise routine. A nutritionist and personal trainer would be able to advise the patients on how best implement these positive changes.
 

What is recovery like?

Normally, the patient can go home two days after the gastric sleeve and will have to take analgesics. There are four phases for a patient to follow post-operation to help transition to a solid food diet. They are:

• Phase 1 – which usually lasts for a week after surgery. Patients should only consume clear liquids and will find that they have no appetite.
• Phase 2 – around 10 days after surgery, most people will start to feel hungry again. At this stage, they start to incorporate foods that are of low nutritional value but adding in more protein. They should drink lots of water and drink protein powder that is sugar-free and mixed with clear liquid. Towards the end of this week, patients can add in Greek yoghurt, oatmeal, mashed potatoes, smoothies and scrambled eggs.
• Phase 3 – patients transition to soft foods including soft fish, eggs, vegetables and soups.
• Phase 4 – after four weeks it is time to transition to solids, sticking to three small meals a day and two snacks. All sugar, processed and low-fibre foods should be avoided.

What are genital warts?

Genital warts (also known as condyloma) are a common type of sexually transmitted infection (STI), manifesting as small growths or lumps, usually pink in colour, around the genitals. They frequently occur in clusters, although sometimes there may be only a single wart. Spread by skin-to-skin contact during vaginal, anal or (occasionally) oral sex, genital warts are the most obvious symptom of infection by the human papilloma virus (HPV).

Genital warts rarely cause serious pain or discomfort themselves, but certain strains of HPV are associated with causing cancer, particularly cervical cancer, so it is important for women who have found genital warts to have regular cancer screenings.

What are the symptoms of genital warts?

Genital warts are themselves symptoms of HPV. They affect the moist tissue of the genitals and can vary in appearance. They may appear as small, flesh-coloured bumps or pale, cauliflower-like structures. They can be either hard or soft, and although they are usually painless some may cause irritation or even bleed.

They can appear anywhere on the genital or anal area, including the tip and shaft of the penis and the scrotum in men; the vulva, the walls of the vagina, and the cervix in women; and around the anus in both sexes. Sometimes, infection will not be immediately obvious because the warts are too small to see, and may even be inside the vagina, the opening of the urethra or the anus.

 If you experience the following symptoms, you should get yourself checked out by a doctor:

• Small, grey or flesh coloured bumps around the genitals or anus
• Itching, burning or pain in the infected area
• Bleeding during sexual intercourse
• Changes in flow during urination that doesn’t go back to normal
• Abnormal vaginal discharge

If your sexual partner is showing any of these symptoms, it is also worth visiting a doctor in case you have been infected.

Causes of genital warts

Genital warts are caused by the human papilloma virus (HPV). There are more than 40 strains of HPV that can affect the genital area, which can be spread through skin-on-skin sexual contact, although in most cases, the immune system kills the virus before you develop symptoms of the infection.

The virus can be passed from person to person regardless of whether or not there are visible warts.

Genital warts can be passed on by:

• Vaginal sex
• Anal sex
• Sharing sex toys
• Oral sex (although this is rare)

Genital warts can’t be passed on by:

• Kissing
• Sharing towels
• Sharing cups, cutlery, etc.
• Sitting on a toilet seat

Can genital warts be prevented?

The best way to prevent the spread of HPV and avoid genital warts is to practice safe sex, using latex condoms, as well as avoiding sexual contact with infected people. However, even using condoms is not a guarantee that there will be no contact with infected skin, because warts can appear in unprotected areas around the genitals such as the scrotum.

There is also a vaccine that protects against some strains of HPV that cause genital warts and the strains that are associated with cervical cancer.

What is the treatment for genital warts?

There are several treatments for genital warts, depending on the nature of the warts and what the doctor recommends:

• Creams or liquids – you be able to apply these yourself at home, or you may have to visit a doctor’s surgery to have the cream applied.
• Surgery – there are techniques to cut, burn, or use a laser to remove the warts.
• Cryotherapy – the doctor may freeze the warts, which usually takes several sessions.

In some people, treatment is ineffective, while in others the warts return while the virus is still present in the patient’s body. There is no definitive cure, but in time the immune system may clear the body of the virus by itself.

Hemorrhoid surgery (piles) is surgery that is done to treat the veins that have been swollen or expanded around the anus. Hemorrhoid surgery is indicated when the patient has itching in the anus, anal bleeding, pain or gore. Piles operation can be carried out using different techniques, the most common is the hemorrhoidectomy, which involves removing hemorrhoids and leave the area sterile gauze to slow the bleeding. Another method is stapled hemorrhoidopexy (also called PTT or Longo method) which involves inserting a mechanical seaming anal rectal excising the excess tissue and, simultaneously, the mucosa with metallic suture points and hemorrhoids are repositioned in his natural position. There is also a surgical procedure to cure hemorrhoids that does not involve the removal of tissue: dearterialization guided transanal hemorrhoidal doppler (THD method), a minimally invasive and virtually painless technique that involves locating, with a Doppler probe and suture the hemorrhoidal artery that carries blood to hemorrhoids. In the same operation, mucosal prolapse has been placed on your site.

A hernia appears as a lump, most commonly in the abdominal or groin area. They occur when an organ, often the bowel, protrudes through the cavity which normally contains it.

What is an inguinal hernia?

A hernia occurs when part of the internal organs or tissue pushes through a weakness in the muscle wall. An inguinal hernia is said to occur when part of the bowel or fatty tissue pushes into the groin at the top of the thigh. It is also the most common type of hernia, particularly in a male. Inguinal hernias are rare in females.

What are the symptoms of an inguinal hernia?

Symptoms of an inguinal hernia are a swelling or a lump in the groin or an enlarged scrotum. There may also be associated pain or discomfort, pain when coughing or lifting, or a dragging sensation in the groin. A bulge either side of the pubic bone could also be a sign of an inguinal hernia.

The hernia may be pushed back in when lying down, however complications can occur whereby the hernia gets stuck or trapped and obstructs the bowel, or the hernia becomes strangulated, whereby the blood supply gets cut off. This is potentially very serious, even life-threatening and requires immediate attention. Symptoms of a strangulated hernia include vomiting and nausea, fever, sudden pain, a bulge that turns red or purple, or an inability to pass stools or gas.

What causes an inguinal hernia?

In males the testicles descend during development via a small opening in the groin. This process leads to a weakness in the abdominal wall and is the cause for inguinal hernias. In a boy there is usually a sac which accompanies the testis. Generally it is supposed to close but occasionally the sac remains, leading to a hernia.

In adults, undue straining such as heavy lifting, violent coughing or prolonged straining on the toilet may cause the hernia to develop due to the underlying weakness in the groin. Loss of elastic tissue due to the ageing process also leads to inguinal hernias. It is not unusual for hernias to occur in both groins. 

How can an inguinal hernia be prevented?

Avoiding undue pressure in the abdomen by straining when passing stool or urinating or carrying and moving heavy loads can reduce the risk of an inguinal hernia, however many hernias may be unavoidable as they have no apparent cause. Strain on the abdominal muscles can be reduced by maintaining a healthy weight, eating a high-fibre diet and stopping smoking.

What is the treatment for an inguinal hernia?

Surgery is the usual treatment for inguinal hernias. In some patients a non-surgical option, such as a hernia truss, may be appropriate. Occasionally it may be appropriate to wait and watch and monitor the hernia. Surgery becomes an emergency for hernias that cause severe pain or that have developed complications. Strangulation, where the bowel has become trapped, is one such complication and it requires immediate treatment to restore the blood supply via surgery. 

What is pruritus ani?

Pruritis ani is the medical term for an itchy bottom or irritation of the skin around the anus (“pruritis” refers to itching sensations of the skin). An itchy bottom is a common symptom that can be caused by a number of conditions. Despite this, patients are often reluctant to see a doctor about it as they are embarrassed. It is thought to be more common in men than women.

Itching may get worse at night or after defecation. It is advisable not to scratch, as this can cause tiny breaks in the skin, which, combined with the general moisture and humidity of the anal area, cause more irritation and the itching gets worse

There are two main types of anal itching:

• Primary anal itching (idiopathic): has no underlying cause, and is the most common type.
• Secondary anal itching: pruritis is due to an underlying cause such as an infection, dermatological problems, systemic diseases, etc.

Causes of an itchy bottom

Some possible causes of anal itching include:

• Hygiene – over-cleaning and under-cleaning the anus can both lead to itching.
• Skin irritants, such as soaps
• Excessive rubbing of the area with rough toilet paper or wet wipes
• Skin conditions, e.g. dermatitis, psoriasis, etc.
• Anorectal conditions, e.g. piles, anal fissures, anal fistulas, etc.
• Infections, including STDs
• Parasites, e.g. hookworm and threadworms, which lay eggs in the anal folds
• Systemic diseases, e.g. inflammatory bowel disease (IBD), diabetes, jaundice, etc.
• Excess sweating or humidity
• Some foods or beverages with dietary irritants, such as spicy or acidic foods
• Diarrhoea or constipation
• Psychological problems, e.g. stress or anxiety

Can an itchy bottom be prevented?

Some tips to prevent anal pruritus or stop it getting worse are:

• Resist the urge to scratch. If you are prone to scratching in your sleep, wearing cotton gloves at night and keeping your nails trimmed can help
• Keep the perianal area clean and dry. In people with anal itching it is recommended to wash with clear water (without soap) after defecation and pat dry, since wiping can further irritate the area.
• Do not use soap, bath oils, or other chemical products when cleaning the anal area
• Eat foods with high fibre content, to avoid diarrhoea and constipation
• Avoid spicy or acidic foods and drinks with caffeine
• Avoid wearing tight underwear

What is the treatment for an itchy bottom?

The treatment of anal itching usually focuses on maintaining a proper routine for proper hygiene. If there is a secondary cause, the treatment will vary.

In general, the basic treatments for anal itching include:

• Topical medication – various creams and ointments exist to help relieve itching and irritation. It is not recommended to use more than one type at once or to use any cream or ointment for longer than a week.
• Oral medication – may be prescribed if there is an infection.

You should see a doctor if:

• The itching doesn’t ease within a few days
• Comes back frequently
• You are experiencing itching elsewhere on your body
• Struggling to sleep due to itching

What is laparoscopy?

Laparoscopy is a minimally invasive surgical technique which allows the surgeon to operate without the need for deep or large incisions in the skin. This means the recovery period is generally shorter, there is less pain after the operation, and scarring is reduced significantly for the patient. This technique is also known as keyhole surgery.

Why is it done?

Laparoscopy can be used to both treat and diagnose a range of conditions across specialties such as surgery, gynaecology, gastroenterology, and urology. Laparoscopy may be used in investigation, to check symptoms and attempt to reach a diagnosis, for example in cases of ovarian cysts, fibroids, pelvic inflammatory disease, and appendicitis. Laparoscopy can also be used to take a biopsy (a small sample of tissue) meaning it can be used to investigate certain cancers, e.g liver cancer, ovarian cancer, pancreatic cancer, and many more.

As a surgical technique, laparoscopy is especially useful as it allows for minimal scarring and a shorter recovery period, which is advantageous to the patient. Laparoscopy can be used as a surgical technique in many situations, such as:

• Weight loss surgery
• Removal of the gallbladder as a treatment for gallstones
• Removal of the appendix
• Repairing stomach ulcers
• Hysterectomy
• Treating ectopic pregnancy
• Removal of organs affected by cancer

What does it involve?

Laparoscopy is performed under general anaesthetic. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them. The surgeon uses small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on. 

How do you prepare for laparoscopy?

Generally, you will be asked not to eat or drink anything for 6-12 hours before the procedure. You will also be asked to stop taking blood-thinning medication a few days before the procedure takes place. If you are a smoker, your surgeon may advise you not to smoke for a few days before the procedure, as smoking can delay the healing process.

Aftercare

As laparoscopy is a minimally invasive procedure, you can generally go home either on the same day or the day following surgery. Someone will need to accompany you home as you will be advised not to drive for the 24 hours following the procedure.

Recovery from laparoscopy depends on the type of procedure performed. After diagnostic laparoscopy, for example, you may be able to resume normal activity after five days. If surgery is more minor, for example ulcer repair, normal activity may be resumed in around three weeks. Major surgery, such as hysterectomy or organ removal (e.g kidney) typically takes longer – up to 12 weeks. Your surgeon or doctor will advise you on how to clean your stitches and keep wounds clean.

Expect to feel tired or somewhat drained after surgery for a few days, but this should pass as your body uses less and less energy as the recovery process goes on. If you experience any pain, you can take over-the-counter medication pain relief to reduce it.

Alternatives to laparoscopy

Laparoscopy is a minimally invasive technique which is used as an alternative to traditional open surgery. Open surgery may be necessary in certain situations and your surgeon will speak to you regarding your options before making a decision as to which type of surgery will be performed.

What is pancreatitis?

Pancreatitis is the inflammation of the pancreas, which is a gland found behind the stomach. The pancreas is key to the digestion of food, through the production of certain enzymes as well as the production of hormones that aid in the processing of blood glucose levels. There are two types of pancreatitis; acute and chronic. Acute pancreatitis is when the pancreas becomes inflamed suddenly. Chronic pancreatitis is when the pancreas becomes permanently damaged due to inflammation of the pancreas over many years.

What are the symptoms of pancreatitis?

The symptoms of acute pancreatitis include:

• Sudden abdominal pain
• Fever
• Diarrhoea
• Nausea & vomiting

The symptoms of chronic pancreatitis include:

• Repeated, and often severe abdominal pain (sometimes accompanied by nausea)
• Oily, bad-smelling stools

If you experience frequent abdominal pain, it is important to see a specialist.

What causes pancreatitis?

Acute pancreatitis is thought to occur when digestive enzymes activate whilst still in the pancreas, causing irritation of the pancreatic cells and hence inflammation. Acute pancreatitis has also been linked to both gallstones, alcohol consumption, infections, and some medications.

Chronic pancreatitis has largely been attributed to long-term alcohol abuse, smoking, hereditary genetic mutations and immune system problems.

In some cases, the cause for a pancreatitis diagnosis is never confirmed.

How is pancreatitis diagnosed?

There are a number of tests used to make a diagnosis, such as:

• Blood tests to check for enzyme levels in the pancreas.
• Stool tests to measure fat levels. Oily stools can indicate that there are problems with the digestive system.
• MRI or CT scans to check for gallstones.

What is the treatment for pancreatitis?

Treatment for acute pancreatitis looks to support bodily functions until inflammation has subsided. The first step in treating acute pancreatitis is to let the pancreas heal, and for the inflammation to subside. To do so, you must be treated in hospital where you will receive intravenous fluids to replace lost fluids, and medicines to manage pain. Fasting for a few days also helps the pancreas to recover.

Once the pancreas has recovered, doctors can get to work on treating the underlying cause of pancreatitis. Frequently, such additional treatments can include:

• Pancreas surgery – sometimes it is necessary to either remove damaged pancreatic tissue, or to drain excess fluid from the pancreas.
• Gallbladder surgery – removing the gallbladder may be necessary if gallstones are the cause of your pancreatitis.
• Treating alcohol dependency – if alcohol abuse is the cause of your pancreatitis, then you may be entered into an alcohol addiction program.

For those suffering from chronic pancreatitis, then further treatments might be needed, including:

• Lifestyle changes – adopting a low-fat, nutritious diet, avoiding alcohol and stopping smoking tends to show the best results for people suffering from chronic pancreatitis.
• Enzyme supplements – these assist in the digestion of food and can be taken with each meal.
• Pain medication – chronic pancreatitis causes continual abdominal pain, so managing this pain is often needed.

What are haemorrhoids?

Haemorrhoids, commonly known as piles, are swollen veins in the anus or lower part of the rectum. They are a very common ailment. Haemorrhoids may be either internal or external. External haemorrhoids generate protuberances in the ring of the anus on the outer side, making them easier to diagnose and can cause pain when sitting, in addition to traces of blood when defecating. On the other hand, internal haemorrhoids occur inside the anus causing bleeding in the stool and itching in the anal region.

What are the symptoms of haemorrhoids?

The main symptoms of haemorrhoids are:

• Bleeding from the rectum
• Anal itching
• Anal pain, especially when sitting
• Pain when passing stool
• Feeling one or more hard and tender bumps near the anus

What causes haemorrhoids?

Haemorrhoids occur due to increased pressure in the anus. They can be caused by:

• Effort during bowel movements
• Constipation
• Sitting for extended periods of time
• Pregnancy or childbirth

Can they be prevented?

To prevent haemorrhoids, it is necessary to avoid constipation. For this reason, it is important:

• To drink plenty of hydrating liquids
• Eat a diet rich in fibre
• Use stool softeners to prevent straining if you are constipated

How are haemorrhoids treated?

In the case of external haemorrhoids, the treatment consists of applying creams and warm water in the affected area. In cases of severe pain, you can take painkillers. As for internal haemorrhoids, surgical intervention may be necessary to remove them.

What is the pilonidal sinus?

A pilonidal sinus is a small tunnel in the skin which can fill with pus or fluid, resulting in either a cyst or abscess. These usually occur in the top of the buttocks where they divide. They do not always produce symptoms, however, if it becomes infected it requires attention. If you are aware of a pilonidal sinus, but it is not infected, it is important to take a ‘watch and wait’ approach. 

What are the symptoms of a pilonidal sinus?

If the pilonidal sinus becomes infected, then a cyst or abscess can form which can cause pain and discomfort, particularly when sitting down. Hence, infected pilonidal sinuses are common in people who sit down a lot, such as lorry or taxi drivers.

Signs of an infected pilonidal sinus are:

• swelling, pain and tenderness
• red skin around the cyst
• pain when sitting
• pus

What causes a pilonidal sinus?

The cause of a pilonidal sinus is still unknown, however, it is thought to be caused by a combination of the following:

• Friction from sitting down a lot, which can cause an ingrown hair which leads to a pilonidal sinus forming.
• A change in hormones. Pilonidal sinuses form after puberty. 

How can an infected pilonidal sinus be prevented?

It can help to keep the area very clean, and to avoid sitting for long periods of time. 

What is the treatment for a pilonidal sinus?

If the infected pilonidal sinus is not too painful or advanced, then antibiotics will be prescribed to fight the infection. However, this treatment does not fully heal the sinus, so after the infection is gone, it is important to keep the area clean and hair-free with frequent shaving.

If the infection is particularly bad, the abscess might be lanced to drain the pus, hair and blood from the sinus. Once it is healed, it is important to pay attention to the site and keep it clean. Depending on the size of the abscess, this procedure will be done either under local or general anaesthetic.

Surgery can also be carried out to remove the sinus altogether. The wound will either be left to heal openly, or it will be flattened and closed with stitches. Both have their advantages and disadvantages. Open healing has a lower risk of the sinus returning, however, recovery time is up to 12 weeks. Closed healing has a quicker recovery time, but the chances of infection returning are higher. 

What is rectal prolapse?

A rectal prolapse is when part of the rectum protrudes through the anus. The rectum is at the end of the large bowel and is where the faeces collect before passing through the anus as a bowel movement. The rectal is made up of three layers, the rectal wall lining (mucosa), a layer of muscle (muscularis propria) and a fatty tissue that surrounds the rectum (mesorectum). If the wall of the rectum sticks out through the anus, it is a rectal prolapse.

What are the types of rectal prolapse?

The three types of rectal prolapse are:

• Full-thickness rectal prolapse – which is the most common type and is when the wall of the rectum sticks out through the anus.
• Mucosal prolapse – when the lining of the rectums protrudes through the anus.
• Internal rectal prolapse – the rectum folds in on itself but does not stick out of the anus.

What are the symptoms of rectal prolapse?

A lump or swelling coming out of the anus may be noticeable when having a bowel movement. If the prolapse gets worse, it could also protrude when coughing, sneezing or standing up. If the prolapse is an internal rectal prolapse, it may not feel like the bowels are fully emptying. Other symptoms of a rectal prolapse include:

• Difficulty in controlling bowel movements
• Blood Discomfort
• An ulcer

What causes rectal prolapse?

A rectal prolapse is often associated with weak muscles in the pelvis. These are triggered by pregnancy, constipation, diarrhoea and a lot of coughing due to conditions such as cystic fibrosis or whooping cough. As women age, a rectal prolapse can happen at the same time as a prolapsed uterus or bladder. The pelvic floor muscles weaken over time or weaken after having given birth.

How to diagnose rectal prolapse

A rectal prolapse is diagnosed following a rectal examination. Further tests may be needed, which may include a proctography, colonoscopy or endoanal ultrasound.
 

How is rectal prolapse treated?

In children, rectal prolapse usually gets better without any treatment. Adults are recommended to treat constipation by eating high-fibre foods or taking laxatives. Surgery may be offered with the type of surgery depending on the type of prolapse, the patient’s age and a history of medical problems. There are two types of surgery.
 

• Abdominal surgery – involves making a cut into the abdomen and is only used for full-thickness prolapse.
• Perineal surgery – involves cutting the prolapse itself and is generally performed on older people.

What is rectal surgery?

Rectal surgery covers a large number of procedures used to treat conditions that affect the rectal area and colon. The disorders that rectal surgery addresses include:

• Haemorrhoids
• Anal fissures
• Fistulas
• Rectal prolapse
• Colorectal cancer
• Types of Inflammatory Bowel Disease (IBD) such as Crohn’s disease and ulcerative colitis

Procedures that are a type of rectal surgery include:

• Colectomy
• Colostomy
• Endoscopy
• Colonoscopy
• Haemorrhoidectomy
• IBD surgery
• Resection
• Internal sphincterotomy
• Rectopexy

Why would you need rectal surgery?

Surgery might be recommended for any of the above conditions if other means of treatment have failed, or if the condition is severe enough to require surgical intervention.

What does it involve?

Colectomy:

• The removal of some or all of the colon.
• Segmental colectomy – the diseased section of the colon is removed, and the ends of the bowel are then joined together.
• Polypectomy – cancerous polyps are removed using a colonscope which is inserted into the rectum, and a loop is passed through the colonscope to remove the polyp.
• Total colectomy – the whole colon is removed and a new pouch is formed and joined to the anus.

Colostomy:

• Also known as a stoma, a colostomy is an opening connecting the colon to the surface of the abdomen where a stoma is attached to allow the removal of waste from the body.
• These can either be temporary or permanent.

Endoscopy:

• A tube with a camera at the end is inserted through a small incision in the abdomen, allowing the surgeon access to the abdomen and to perform certain procedures.
• Often an endoscopy is carried out to remove tumours or to make a diagnosis.

Colonoscopy:

• A tube with a camera at the end is inserted through the rectum, and allows the surgeon to see a camera image of the colon.
• This procedure is usually carried out for diagnostic purposes.

Haemorrhoidectomy:

• Initial treatments for haemorrhoids are usually non-surgical, however, if these do not provide sufficient relief, then surgery will be recommended.
• Local anaesthesia is given, and incisions are made around the anus to remove the haemorrhoids.

IBD surgery:

• If the IBD has caused extreme intestinal pain that has resulted in hospitalisation, then surgery may be recommended.
• Surgery to remove the colon (colectomy) can cure ulcerative colitis, and can provide relief for those suffering from Crohn’s disease.

Resection:

• Broadly, a resection is a procedure that removes diseased sections of tissue or organ.
• Different resections can treat colorectal cancer and various intestinal issues.

Internal sphincterotomy:

• Used to treat anal fissures, local anaesthetic is applied to the area and where small incisions are made to the sphincter to relieve pressure caused by the anal fissure.
• Sometimes general anaesthetic is required.
• This procedure does not cure anal fissures, but allows the muscles to relax, aiding the healing of the anal fissure.

Rectopexy:

• Used to treat rectal prolapse, the procedure repositions the internal structures of the rectum.

How to prepare for it

Depending on which type of procedure and disorder you have, preparation for surgery will differ. For more intensive surgery, health will need to be monitored and improved before surgery, and often a period of fasting the day before surgery will be required.

Post-operative care

Recovery from rectal surgery differs depending on the type. Those carried out laparoscopically (keyhole surgery) will often allow same or next day discharge from hospital. Other, more intense surgeries may require a stay in hospital for up to two weeks. 

What is an umbilical hernia?

An umbilical hernia is a type of hernia, which refers to when part of the internal organs protrude through a weakness in the surrounding cavity.

In the case of an umbilical hernia, abdominal fat or part of the bowel passes through an area around the navel.

What are the symptoms of an umbilical hernia?

Umbilical hernias are very common, particularly in babies and are characterised by a bulge around the navel that might get bigger when laughing or coughing. They are usually painless in infants and children, however, in adults who develop an umbilical hernia, the swelling may also be accompanied by pain and discomfort.

What causes an umbilical hernia?

An umbilical hernia develops as a result of a weakness in the abdominal wall at the navel. If the hole through which the umbilical cord passes through during pregnancy doesn’t close properly after birth, it can cause a hernia either at birth or later on in life. In adults, too much pressure in the abdominal cavity can increase the possibility of an umbilical hernia.

How can an umbilical hernia be prevented?

There is little that can be done to prevent umbilical hernias at birth, however, there are certain risk factors for adults. Anything that increases pressure in the abdominal cavity, such as obesity, straining while moving or lifting heavy objects, a persistent heavy cough, ascites (fluid in the abdomen, and having multiple pregnancies (i.e. twins, triplets, etc.), can increase the risk of an umbilical hernia.

What is the treatment for an umbilical hernia?

In infants, an umbilical hernia very often clears up on its own – the hernia goes back in and the muscle reseals over it. In adults, an umbilical hernia will generally get worse over time.

In most cases, it is advised to wait until a child has reached four of five years of age to see if the hernia disappears before considering surgery, except in cases where the hernia is very large or there are other complications.

In most adults, umbilical hernias are treated with surgery to push the abdominal tissue back into place and seal the abdominal wall. Complications can include obstruction where a section of bowel gets stuck outside the abdomen and can cause nausea, vomiting and pain and discomfort. Strangulation, whereby the blood supply to the section of bowel forming the hernia is cut off, is a potentially serious complication and needs emergency treatment to prevent the trapped tissue from dying.