Nuffield Health
Warwickshire Hospital
Old Milverton Lane
Leamington Spa
Warwickshire
CV32 6RW
Haemorrhoids
Everyone has swellings in the anal canal (back passage) called anal cushions. These bulges in the lining of the anal canal act like the washer on a tap and help to prevent leaks from the back passage and maintain continence. Over time these swellings can lose their normal structure and become enlarged. This can cause them to bleed, or protrude outside the anus (prolapse). When this happens they are called haemorrhoids, or piles.
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They can lead to symptoms including bleeding, discomfort, itching and a feeling of incomplete bowel emptying. It is not known why some people suffer from haemorrhoids and others do not. There is an association with constipation and straining, but they can be associated with a normal bowel habit. They are more common in some families and during or after pregnancy. Up to one in three people will suffer from haemorrhoids during their lifetime. There are a number of different treatments for haemorrhoids, which Mr Ferguson will be pleased to discuss with you.
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Treatments for Haemorrhoids
1 / Lifestyle Changes & Conservative Treatment
These are most effective if your haemorrhoids are related to constipation or straining at stool. They include maintaining hydration, increasing dietary fibre and decreasing the time you spend on the loo. Sometimes Laxatives or 'over the counter' creams can be sufficient to control symptoms.
2 / Rubber Band Ligation
This involves using a special instrument which is inserted through the anus to put a very tight elastic band around the base of the haemorrhoid. This cuts off some of the blood supply to the haemorrhoid swelling and fixes the lining of the anal canal in place to prevent further prolapse. It is normally perfomed in endoscopy, but can be perfomed in clinic if Mr Ferguson is reassured there is no other cause for your symptoms. It is uncomfortable to have perfomed, and can leave you with a feeling of fullness in your rectum for a few days. This is generally controllable with simple pain killers.
3 / Surgery
Surgery to remove haemorrhoids has a high success rate, especially for external haemorrhoids.
However, the procedure is very painful to recover from, and often requires around 2 weeks off work. It also carries a risk of damage to your anal sphicters. This could result in incontinence.
For these reasons, Mr Ferguson only offers formal surgery to remove haemorrhoids if other measures have failed to help you.
Anal Fissure
What is an Anal Fissure?
An Anal fissure (Fissure-in-Ano) is essentially a tear in the anus. This generally occurs because of trauma, most commonly because of passing a hard stool. Most fissures will heal in a week or two providing stools are kept soft. However, some fissures can fail to heal and then become a chronic problem.
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You may have an anal fissure if you have pain and bleeding when opening your bowels. Often, the pain from a fissure is initially very sharp - like 'passing glass', but then continues as an ache for many hours after passing a motion. This can disturb sleep and lead to significant problems in daily functioning. This happens because in a chronic fissure, the anal sphincter becomes exposed, and goes into spasm. This in turn prevents the anal tear from healing.
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Treatments for anal fissure focus upon relaxing the sphincter muscle to allow the tear in the skin to heal.
Treatments for Anal Fissure
1 / Laxatives and Rectal Ointments
During the healing process, it is important to keep your stools soft and regular. It is equally important not to make the stools too loose as this can also worsen fissure symptoms. Mr Ferguson will discuss with you how best to manage you rbowels during this process.
In addition to keeping your stools soft, first line treatment includes a cream to be applied around the anus, which relaxes the sphincter a little. These creams do not cause leaking, but can cause headaches, as they also relax the blood vessels in your brain.
2 / Intersphincteric Botulinum toxin Injection
If creams are unable to relax the muscles suffieciently for the fissure to heal, then consideration could be given to an injection of Botulinum toxin ('Botox'). This is performed under a short general anaesthetic, which will also allow Mr Ferguson to further assess your fissure, and identify reasons why it may not have responded to simple treatments. Botox is often very effective, but can result in some leaking of wind or, in rare circumstances, stool. The injection wears off after 3 months, so this leaking is temporary.
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Botox Injections can be repeated if full healing has not been achieved in 3 months.
3 / Surgery
If your fissure has not healed despite the above measures, then Mr Ferguson will discuss a more formal operation with you. Operations for anal fissure can be very effective, but most involve permanent division of a small amount of your sphincter muscles. Providing you have strong pelvic floor muscles, this is often well tolerated, but in the worst case, an operation can result in permanent leaking from your bottom.
Anal Fistula
What is an Anal Fistula?
An anal fistula happens when a connection develops between the anal canal or low rectum and the skin near the anus. The majority happen because of an infection in one of the glands in your anus, but they can also happen because of other conditions such as Crohn's Disease and Bowel or Anal Cancer.
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You may have an anal fistula if you are suffering from recurrent infections in or around your back passage, or if there is regular bleeding or discharge from your back passage.
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If you could have a fistula, it is very important to see a specialist like Mr Ferguson. While the discharge or infections can be annoying, there could be a serious underlying cause, or ongoing damage to the muscles around your bottom which could lead to leaking in the future.
Treatments for Anal Fistula
It is very important that your fistula is assessed by a specialist such as Mr Ferguson. The anatomy of fistulas is complex, and they can come from many different areas in the lower bowel:​​​​​​​​​​​​​​
It will therefore be very important for you to have an MRI scan of your bottom so that Mr Ferguson can see where your fistula starts and ends. He will then be able to discuss appropriate treatments with you. Mr Ferguson holds a strong commitment to maintaining your future bowel function, so will recommend a course or treatment which minimise the chances of affecting your continence.​
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Laying Open a Superficial Fistula
If your fistula is just beneath the skin, or only involves a small amount of your sphincter muscles, then it may be appropriate to cut out the fistula under a general anaesthetic. This has a high success rate, but is only appropriate if it will not hold a significant risk of in continence.
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Insertion of a Seton (Draining Stitich)
If you have a higher fistula, it is not appropriate to cut the fistula out as it would damage your continence. Mr Ferguson will therefore recommend the insertion of a stitch through the fistula called a Seton, again, under a general anaesthetic. It will not get rid of the fistula, but it aims stop your infections, and enable planning towards a further operation to get rid of the fistula once no infection is present.
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Ligation of Intersphincteric Fistula Tract (LIFT) Procedure
Mr Ferguson's preference for definitively treating a high fistula is a LIFT Procedure. In simple terms, this involves an operation under general anaesthetic to go between the muscles of your bottom, find the fistula, and tie it off. It is complex surgery, and Mr Ferguson will discuss it in detail if it is appropriate in your case. For this to be performed you will need to have had a Seton stitch in place for a couple of months to allow any infection to settle.
