Colorectal Diseases

The practice of Colon and Rectal Surgery provides care for the following conditions:

Colorectal Cancer (“Bowel Cancer”)

Bowel cancer is the second most common cancer in both men and women in Australia and is more common in people over the age of 50.

Bowel cancer, also known as colorectal cancer, develops from the inner lining of the bowel and is usually preceded by growths called polyps, which may become invasive cancer if undetected. Depending on where the cancer begins, bowel cancer may be called colon or rectal cancer.

Symptoms of bowel cancer include:

• Change in bowel habit with diarrhoea or constipation

• Blood in the stools

• Abdominal pain, bloating or cramping

• Anal or rectal pain

• A lump in the anus or rectum

• Weight loss

• Unexplained anaemia.

The primary way of diagnosing bowel cancer is with a colonoscopy.

The mainstay of treatment of bowel cancer is surgery to remove the effected segment of bowel. In some patients chemotherapy and/or radiotherapy may be beneficial, however these therapies are not required in all patients.

More information:

https://cssanz.org/index.php/patients/bowel-cancer

https://www.bowelcanceraustralia.org

http://www.cancervic.org.au/cancer-information/cancer-types/cancer_types/bowel_cancer

Inflammatory bowel disease (Crohn’s Disease & Ulcerative Colitis)

Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of your digestive tract. Types of IBD include:

• Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.

• Crohn's disease. This type of IBD is characterised by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues. Crohn’s can effect the gut at any site, including the small and large bowel.

Both ulcerative colitis and Crohn's disease usually involve severe diarrhoea, abdominal pain, fatigue and weight loss. IBD can be debilitating and sometimes leads to life-threatening complications. The management of IBD is usually with various forms of medication, and surgery is reserved for when medications are not working or a serious complication has occurred. As such patients with IBD are often managed by both a colorectal surgeon and a gastroenterologist.

More information:

https://cssanz.org/index.php/patients/ulcerative-colitis

https://cssanz.org/index.php/patients/crohns-disease

Diverticular Disease

Diverticular disease is a benign (non cancerous) condition of the colon (large intestine or ‘bowel’). It is also known as diverticulosis and consists of small pockets (diverticula) that bulge out of the colon, through its muscle wall. When the pockets or diverticula get inflamed the resulting condition is known as diverticulitis.

Most people with diverticular disease have no symptoms and it is diagnosed ‘incidentally’ with a colonoscopy or a CT scan. People with diverticulitis (inflammed diverticula) often present with lower abdominal pain, fever and generally a change in bowel habit (either constipation or sometimes diarrhoea). The diagnosis of diverticulitis is made with a CT scan. A mild attack of diverticulitis can be treated as an outpatient but sometimes admission to hospital is required, with or without antibiotics depending on the condition of the patient. Severe cases of diverticulitis can result in peritonitis (that usually requires emergency surgery), an abscess (that usually requires drainage) or a fistula, which is an abnormal communication between the bowel and another structure such as the bladder (that usually requires surgery). Most diverticulitis that is not considered severe can be managed without surgery. Colonoscopy may be required about 6-8 weeks after the attack if there is confusion about the diagnosis.

More information: https://cssanz.org/index.php/patients/diverticular-disease

Haemorrhoids, fissures, fistulae

Haemorrhoids, also called piles, are normal blood vessels in the anal canal. In their normal state, they are cushions that help with stool control. They cause symptoms when enlarged, swollen or inflamed. The signs and symptoms of haemorrhoids depend on the type present. Internal haemorrhoids often result in painless, bright red rectal bleeding when passing a bowel motion. External hemorrhoids often result in pain and swelling in the area of the anus. Symptoms frequently get better after a few days. A skin tag may remain after the healing of an external haemorrhoid. Colonoscopy or sigmoidoscopy is often needed to confirm the diagnosis and rule out more serious causes.

More information: https://cssanz.org/index.php/patients/haemorrhoids

An anal fissure is a small tear in the thin, moist tissue (mucosa) that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter). Treatment most commonly involves the use of stool softeners and ointments, but may involve a minor operation.

More information: https://cssanz.org/index.php/patients/anal-fissure

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the bowel (anus).

Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland. Surgery is usually needed to treat anal fistula.

More information: https://cssanz.org/index.php/patients/anal-abscess-anal-fistula

Incontinence

Faecal incontinence is a term used to describe leakage of liquid or solid stool from the bowel. Poor bowel control can be caused or made worse by a number of things including certain health conditions or medicines taken for other problems. A number of tests are often needed to help find out what the cause is, and to plan treatment. Management is determined by the severity and frequency of the problem, and may involve simple lifestyle changes, but can also include surgery.

More information: https://cssanz.org/index.php/patients/faecal-incontinence

Assessment of rectal bleeding / Colonoscopy

Bleeding from the bowel is a common symptom. Most often it is from a minor problem at the lower end of the bowel, however it can represent a serious disease such as bowel cancer. As such it is important that you see your doctor and have this investigated thoroughly.

Colonoscopy is the examination of the large bowel and last part of the small bowel with a fiber optic camera on a flexible tube passed through the anus. It can provide a visual diagnosis (such as cancer, polyps and inflammation) and grants the opportunity for biopsy or removal of most polyps. Once polyps are removed, they can be studied with the aid of a microscope to determine if they are precancerous or not.

More information:

https://cssanz.org/index.php/patients/colonoscopy

https://cssanz.org/index.php/patients/polyps

Prolapse

A prolapse is a protrusion of some part of the bowel through and outside the anus.

Protrusion of the bowel occurs during defaecation which at first goes back by itself. Later it needs to be reduced by hand. There may be discomfort, bleeding and the passage of mucus. Incontinence or poor control of the bowel is a very common complaint. This becomes more severe as the prolapse increases in size. A feeling of constipation or incomplete emptying of the rectum may be an associated symptom. Surgery is usually required to treat a prolapse.

More information: https://cssanz.org/index.php/patients/rectal-prolapse

Pilonidal sinus

A pilonidal sinus is a small hole or tunnel in the skin at the top of the buttocks, where they divide (the cleft). It doesn't always cause symptoms and only needs to be treated if it becomes infected. Infections most common need drainage as well as antibiotics, and some pilonidal sinuses need to be removed by an operation.

More information: https://patient.info/health/pilonidal-sinus-leaflet

Hernias

A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example, the intestines may break through a weakened area in the abdominal wall. Hernias are most common in the groins, but can occur at other sites in the abdomen. Most hernias aren’t immediately life-threatening, but they don’t go away on their own. They can require surgery to prevent potentially dangerous complications, and this can usually be performed laparoscopically (“key hole”).

More information: https://www.healthdirect.gov.au/hernias