Bottom Clinic

Rectal bleeding, pain, itchiness, haemorrhoids, fissures, fistulas, skin tags, leakage... you name it, we deal with it at The Women’s Clinic.

 

None of these conditions are particularly nice to experience however the consolation is that they are very common in our society (especially among women) and with the right treatment they can be resolved.

Child bearing puts us women at particular risk along with the aging process. At The Women’s Clinic we understand your frustration and we would like to reassure you that every one of these situations has a solution. The first step to finding a solution is having an initial assessment. This usually means having a chat and an examination, both of which are made as undaunting as possible at The Women’s Clinic.

Feel free to chat about your specific complaints - in fact the more specific you can be, the more this helps us to find a solution. Don’t delay as ignoring the problem and wishing it away usually only makes the situation worse.

 

Haemorrhoids

What is a Haemorrhoid?

Haemorrhoids

The word Haemorrhoid has a Greek derivation and it comes from a word meaning ‘flowing with blood’. Whilst that is all very interesting, it does not alter the fact that haemorrhoids can cause inconvenience, pain and symptoms that we would otherwise not wish to mention. They are derived from vascular cushions in the anal canal which, in the perfect situation, are meant to be there. However if any situation causes the blood-filled cushions to become dilated and irritated, then you get a whole host of mostly irritating symptoms that require treatment in some form or other.

Why have I got Haemorrhoids?

We New Zealanders are particularly prone to trouble with haemorrhoids and that is thought to be due to our diet, which is relatively high in animal proteins and relatively low in fibre. This puts us on the back foot right from the word go and, to top it off, for us women pregnancy is often the final straw that creates haemorrhoidal mayhem. It is very common for pregnant women and women in the early postpartum period to struggle with symptoms. Obesity and older age are also risk factors for haemorrhoids as well. Hence problems with haemorrhoids are very common for us women and it is really just a case of getting on and dealing with them in whichever stage they are at.

What symptoms do Haemorrhoids cause?

Haemorrhoids come in many shapes and forms and can cause symptoms that are widely variable from woman to woman. Some of the commonest symptoms include painless rectal bleeding that usually occurs with passing a bowel motion and occasionally in between times, pain, itchiness and the presence of irritating anal skin tags. Skin tags are definitely nuisance value and can make hygiene particularly difficult. The good news is that all of these symptoms are treatable and fixable with relatively simple therapies.

What treatment do I need?

Optimal treatment needs to be tailored to the individual with their particular complaints but usually include optimisation of bowel habit and creating bowel health. Topical treatments and minor procedures such as haemorrhoid banding can be performed in the consultation room and is part of the mainstay of haemorrhoidal therapy in most situations. Occasionally surgery is required but not in the majority. It is all about getting assessment and treatment early and avoiding perpetuating the problem into a bigger one. That is why you should come and see us at The Women’s Clinic and we can start you off on the road to bowel happiness. Do not hesitate to contact us for a consultation.

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Anal Fissure

What is an Anal Fissure?

Anal Fissure

Well, this is a condition that you would do well to steer clear of. It is by far one of the most painful of the minor complaints that occur commonly in the back passage. It is most certainly related to a longstanding irregular bowel habit with constipation being the typical precipitating factor. It is literally a split in the skin at the edge of the anal outlet and just like any split in the skin in any part of the body it is a particularly painful issue.

What symptoms do Anal Fissures cause?

Typically a fissure is characterised by intense pain when passing a bowel motion. This pain can last for a few to many hours following and can also be characterised by small volume bright red rectal bleeding as well. It can be an acute problem. Those that are most prone to having this condition are women with sluggish bowels who generally do not have a daily bowel habit. Pregnancy is also a risk factor for this nasty little condition.

What treatment do I need?

The good news, however, is that some fairly simple changes from a dietary and bowel habit point of view can drastically improve the situation and also diminish the chances of it happening again in the future. It is once the situation becomes more chronic (greater than 6-12 weeks) where other treatment options are called on. The key to avoiding needing surgical treatment is to seek expert assessment early, and unlock the keys to making this condition a thing of the past.

Treatment options include topical ointments or injections into the internal anal sphincter. This is done under an anaesthetic as otherwise it would be quite a painful experience. The final solution if none of these treatments have the desired result, is a Sphincterotomy. This is an operation with an excellent success rate but significant potential risks. Like all anal conditions, early management is the key to early success. Make a consultation today.

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Anal Fistula

What is an Anal Fistula?

Anal Fistula

A fistula actually is a tunnel or connection going from the inside of the body to the outside of the body that shouldn’t be there. In the situation of an anal fistula there is a connection between the anus or the rectum and the outside skin. It manifests as an opening around the anus that leaks pus or even faecal staining material or blood. It is always associated with infection, either of a fairly low-grade nature that doesn’t make you feel unwell or of a high-grade nature such as an abscess or a pocket of pus. This will make you feel particularly unwell and cause significant pain down below.

Why did I get an Anal Fistula?

It can occur on its own with no obvious cause or it can be associated with other conditions such as Crohn’s disease or Ulcerative Colitis (Inflammatory Bowel Disease). It is not a particularly easy situation to fix. It does require treatment which lasts over a period of months and relies heavily on the body to fix itself, to a certain degree. However, like any medical condition, it is much better to have the right treatment early and take advantage of the body’s healing powers before the situation becomes more chronic.

What treatment do I need?

Optimisation of management involves imaging the anal area with an MRI scan (Magnetic Resonance Imaging scan). This is particularly good at identifying the tract and its whereabouts with respect to the sphincters and the anal canal. It is only once the anatomy is recreated that treatment can proceed.

The mainstay of treatment is insertion of a Seton. A Seton is, quite simply, a rubber band that is put directly into the fistula tract. This keeps the narrow tunnel open and optimises drainage of the infection so that internal healing can begin. It is a tricky situation to deal with and requires expert management.

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Colorectal Cancer

Colorectal Cancer

Cancer is a dirty word. Let’s face it, we are all petrified to some degree of developing cancer in some part of our body. It is a very natural human fear because we know that the consequences of cancer can be devastating and even deadly. The key, however, is early identification of cancer and early treatment. We know that New Zealanders have one of the highest bowel cancer rates in the world and it is the second most common cause of cancer death in New Zealand. For this reason we all need to be vigilant in picking up the findings early. On a more positive note, we know that approximately 75% of colorectal cancer is curable if it is picked up early enough. Bowel cancer often starts in benign (non-cancerous) polyps of the bowel or rectal wall. These polyps do not cause overt symptoms when they are small however as they grow larger and become cancerous, the symptoms become more obvious. Screening for bowel cancer includes testing of your faeces for minute specks of blood – this is blood that cannot be seen with the naked eye. This is called Faecal Occult Blood Testing and the idea of this is to pick up polyps or small cancers while they are curable.

Who is at risk of developing Bowel Cancer?

Risk factors associated with developing bowel or rectal cancer include increasing age, a family history of bowel cancer – especially if it has affected multiple members of the family at a younger age, the presence of inflammatory bowel disease over a long period of time, the presence of polyps and some other less common risk factors. Bowel and rectal cancers commonly do not cause symptoms until they reach a certain size. This is why we are currently trialling screening for blood in faecal samples in New Zealand. The symptoms that require investigation include a change in your bowel habit that cannot be explained, e.g. increased or decreased frequency of bowel motions, or the presence of blood in the bowel motion. If you are experiencing either of these symptoms then you require further investigation to ensure that cancer is not the cause of your symptoms.

What is the best method of detecting Bowel Cancer?

The best way of ruling out cancer is a colonoscopy which enables direct visualisation of the colon and rectum and allows us the ability to biopsy areas of concern. Other investigations that are also used include CT colonography and barium enema. If cancer has been diagnosed then the most common treatment that is offered is surgical removal of the cancer. Once the cancer has been removed and inspected under the microscopic we are able to tell the size of the tumour and whether it has invaded into other surrounding structures, including lymph nodes or other organs. It will depend on the final microscopic tests as to whether you will be offered chemotherapy or radiotherapy. Rectal cancer is slightly different to colonic cancer in that radiotherapy is more likely to be used before surgery in order to shrink the tumour and enable adequate resection of the cancer.

These treatments are used in consultation with cancer experts (Oncology Specialists). Successful treatment and cure is directly related to how early the cancer has been picked up. So don’t hesitate to discuss with your GP if you think you have symptoms that may need further investigation. At the Women’s Clinic we are focussed on early identification of cancer and this means active investigation of symptoms that may be an early indicator. Feel free to contact us if you have any further questions or would like a consultation.

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Anal Papillomas (Genital Warts)

What is an Anal Papilloma?

Anal papillomas are skin warts that can often be on stalks with finger-like projections. They most commonly occur in clusters, often around the anus or vagina, and are spread by skin-to-skin contact. They are highly contagious.

What treatment do I need?

They are due to infection with the Human Papilloma Virus (HPV).

Whilst treatment to remove the warts can include topical applications or liquid nitrogen treatment, surgical excision is sometimes required for larger or recurrent papillomas.

The relationship between Anal Papillomas and Anal Cancer

The more sinister side of anal papillomas is that they may indicate an infection with a particular type of HPV that is associated with the development of anal cancer. Anal cancer is different to the type of cancer that develops in the rectum or colon and its treatment is also different. Anal cancer is usually visible from the outside but occasionally is not. It is often characterised by a skin lesion that gets progressively larger. The lesion can be firm and tender and can bleed easily. As with any type of cancer the best treatment outcomes are when early detection and management is instituted. It is essential that if you are concerned that you may have a lesion that needs diagnosis then you should bring this to the attention of your family doctor as soon as possible.

What treatment is required for Anal Cancer?

Treatment for Anal Cancer, once diagnosis has been made, is often with radiotherapy only. Surgery may also be required in some situations. Please contact the Women’s Clinic via your GP, if you have concerns and need somebody to take a look.

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Proctitis

What is Proctitis?

Proctitis simply means ‘inflammation of the rectal lining’. Symptoms you may experience most commonly include bloody stools, characterised by specks of blood within or coating the stool itself. This may be associated with diarrhoea or constipation, rectal discharge of a pus-type substance and pain.

Why did I get Proctitis?

The inflammation may be due to an infection which may or may not be sexually transmitted, an autoimmune condition such as inflammatory bowel disease (Crohn’s disease or Ulcerative Colitis) or previous pelvic radiotherapy. Diagnosis is usually made on direct visualisation of the rectal lining. This can be achieved quite easily in the consulting rooms.

What treatment is available?

Once the diagnosis has been made it is then the job of the Specialist to identify the cause of the inflammation. This is not a particularly difficult process, however does require other procedures to be performed, including colonoscopy and culture of the rectal lining, in order to identify an offending organism. It is essential to identify the cause as soon as possible as there are other potentially nasty complications that can occur as a result of untreated Proctitis.

Treatment, of course, depends on the underlying cause for the Proctitis and may include antibiotic therapy for an infection or steroid suppositories for an inflammatory condition. It can be quite a debilitating condition but usually symptoms are greatly improved with either of these interventions. If you think you may be affected, chat with your GP and come and see us at The Women’s Clinic for further investigation.

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Rectal Prolapse

What is Rectal Prolapse and what symptoms does it cause?

Rectal prolapse is a condition which has symptoms that are many and varied. This is due to the fact that a prolapse can occur at any point in the rectum – it may be internal prolapse (or intussusception) or external prolapse. Internal prolapse causes changes to the bowel habit which often make passing a bowel motion quite difficult. It causes obstructive-type defaecation patterns which means that you have the feeling of needing to pass a bowel motion but you are unable to pass one. It may be necessary to put pressure around the anal area in order to allow a normal bowel motion to take place. This obstructive defaecation pattern can be associated with leakage of mucous or a small amount of rectal bleeding. An external prolapse, however, is something that you can see or feel coming out of the back passage. It is flesh-type material that protrudes and may be only in one area or may be circumferential – as in the entire circumference of the rectum protruding from the back passage. This may be relatively easy to put back in into the back passage and only come out again after the next bowel motion. However, as time goes on, this is likely to progress to coming out when you cough or sneeze or after spending a long time on your feet.

Why did I get Rectal Prolapse?

The causes of rectal prolapse may include chronic constipation or diarrhoea, progressive weakening of the connective tissues in the region of the pelvic floor (with increasing age or smoking), damage secondary to pregnancy, childbirth or other more rare conditions.

What treatment do I need?

The key to adequate treatment of rectal prolapse is having a correct diagnosis and this involves careful consultation with you, the patient. Often the symptom complex that you are experiencing will be indicative of the type of prolapse that you have. Scans such as defaecating proctograms or MRI scans will also be useful in accurate diagnosis.

Treatment starts with eliminating any factors that are exacerbating the condition such as constipation or diarrhoea, and then outlining any surgical management that may be required.

There are many operations that can be performed for a prolapse. An external prolapse may be treated with an Anterior DeLorme’s procedure or a simple haemorrhoidectomy. For an internal prolapse however, often abdominal surgery is required and this can be either keyhole surgery or open surgery. If you think that you are experiencing some or all of these symptoms, then it is important to discuss it initially with your GP and then a consultation is the next step in order to make an accurate diagnosis. Feel free to contact The Women’s Clinic if you have any queries regarding this condition.

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For further information or advice: Contact The Womens Clinic on P: 524 8887, 0800 WOMENS or E: reception@womensclinic.co.nz