Anorectal & Pelvic Floor Disorders

Haemorrhoids are swollen blood vessels in the lining of the anal canal that can bleed, itch, prolapse (come out) or become painful. Most are managed with dietary changes, creams and rubber band ligation in the clinic. Larger or persistent haemorrhoids may be treated with a haemorrhoidectomy or other surgical techniques as day surgery.

An anal fissure is a small tear in the lining of the anus that causes sharp pain and bleeding with bowel motions. Most heal with stool softeners and ointments that relax the anal muscle; fissures that do not heal may be treated with Botulinum toxin injection or a minor operation.

An anal abscess is a collection of pus near the anus that causes pain and swelling and is treated by drainage. In some people a fistula, an abnormal tunnel between the anal canal and the skin, remains afterwards and causes persistent discharge. Fistulas can also occur in Crohn's disease.

Treatment is tailored to the path of the fistula and how much of the anal sphincter muscle it involves. Options include fistulotomy, placement of a seton, and sphincter-preserving procedures such as LIFT or an advancement flap, chosen to cure the fistula while protecting continence.

Rectal prolapse occurs when the rectum slides down and protrudes through the anus, usually during bowel motions. It can cause discomfort, mucus, bleeding and difficulty controlling the bowel. Prolapse is repaired surgically, either through the abdomen with a laparoscopic or robotic rectopexy, in which the rectum is lifted and secured, or through the anus for patients who are less fit for abdominal surgery.

Faecal incontinence is the inability to control bowel motions or wind. It is far more common than most people realise and is often related to injury to the anal sphincter during childbirth, previous anal surgery, nerve damage or long-standing straining. Many patients have never discussed it with a doctor.

Assessment may include anorectal physiology tests and an ultrasound of the sphincter. Treatment starts with dietary and medication changes and pelvic floor physiotherapy, and can progress to sacral nerve stimulation, sphincter repair for a defined injury, or other procedures. Our colorectal surgeon's additional fellowship in pelvic floor and anal sphincter physiology means every option can be considered.