1. A review of common colo-rectal conditions
Ian H K Scott
13 April 2016

2. Haemorrhoids Anatomy: Mucosal excess/prolapse in anal canal Symptoms:
Sub-mucosal space filled with multiple arterio-venous fistulae
Symptoms:
Bleeding – bright red, at and after defaecation
periodic
Prolapse – covert
overt
Strangulation

3. Fissure –in-ano Symptoms:
Anal pain at and after defaecation for variable period
Bleeding
Discharge which may be associated with a very low fistula
Examination:
Very high anal tone (in most cases, but some may be normal)
Fissure may be visible
Sentinel tag

4. Fissure-in-ano Treatment:
In general, avoid cathartics. A bulky soft stool is best, so consider Fybogel or other bulking agent
Diltiazem 2% cream - two x one month courses
Sphincterotomy
Low tone fissure presents considerable problem
Conservative management as long as possible
Operation to: 1. Close fissure with sutures
2. Cover defect by advancement flap

5. Rectal Prolapse Anatomy:
May be simple mucosal prolapse, when symptoms may be mainly related to mucus discharge
Full thickness prolapse, which is a herniation of the Pouch of Douglas through the anal sphincters
Treatment
Simple mucosal prolapse – sclerotherapy or banding
Full thickness prolapse – Delorme’s procedure or Per-anal proctectomy (Altmeier’s procedure)

6. Diverticular Disease Incidence: Symptoms:
It is said to be present in 80% of 80 year olds
Can occur in much younger patients
Symptoms:
Only c.10% have significant symptoms
Variable bowel habit
Lower abdominal pain relieved by passage of flatus or stool
Abdominal distension
Urgency, occasionally leading to incontinence

7. Diverticular Disease Treatment:
Increase fluid intake and add a bulking agent
Antispasmodic
Operation for unresponsive symptoms
Complications:
Acute diverticulitis
Peri-colic abscess
Bleeding
Fistulation to bladder, vagina, abdominal wall, uterus, ureter

8. Colo-rectal Carcinoma
Presents in many ways, from silent anaemia to disabling symptoms, and as unheralded acute obstruction
Bleeding on its own is an uncommon presentation
Persistent change in bowel habit to loose stools
Tenesmus and mucus discharge in rectal cancer
Be suspicious if woken early in the morning to empty bowels
Be suspicious of symptoms that disturb sleep
Treatment:
Resectional operation aiming for 65% laparoscopic
Rectal cancer often has multi modal treatment