Clear information about common colorectal concerns

Anal fissure

An anal fissure is a small tear in the lining of the anal canal. Although it is a benign condition, the pain can be severe and can make going to the toilet something patients understandably begin to dread.

What symptoms can it cause?

The typical symptom is sharp or burning pain during a bowel movement, which can continue afterwards. Some people notice a small amount of bright red blood on the toilet paper or stool. The discomfort may lead to tightening of the anal sphincter muscle, which can reduce blood flow to the area and make healing more difficult.

Why do fissures happen?

They are often associated with trauma to the anal canal, for example after passing a hard stool or during periods of constipation. Diarrhoea can also irritate the area. A fissure that does not heal, occurs in an unusual position or has other concerning features may need further assessment to rule out another underlying problem.

How is an anal fissure treated?

Initial treatment usually aims to make stools softer and easier to pass and to reduce pain and muscle spasm. Depending on how persistent the fissure is, specialist treatment may include prescribed topical medication, injections to relax the sphincter or an operation. The most appropriate option depends on the individual and is discussed after assessment.

Colorectal cancer

Colorectal cancer, also called bowel cancer, develops in the colon or rectum. Many bowel symptoms have non-cancerous causes, but persistent or unexplained changes are worth investigating because earlier diagnosis generally gives more treatment options.

What symptoms may need investigation?

Possible warning signs include a persistent change in bowel habit, blood in the stool or bleeding from the bottom, unexplained abdominal pain or bloating, weight loss, tiredness associated with anaemia, or a feeling that the bowel has not completely emptied. None of these symptoms automatically means cancer, but they should not simply be ignored.

How is it investigated?

Assessment may include blood tests, a stool test such as FIT, colonoscopy and scans. Colonoscopy is particularly useful because it allows the bowel lining to be seen directly and enables tissue samples to be taken from anything that looks abnormal.

What happens if cancer is found?

Treatment is planned according to where the cancer is, its stage and the patient's overall health. Surgery is a major part of treatment for many colorectal cancers. Chemotherapy and, particularly for some rectal cancers, radiotherapy may also form part of treatment. Cases are usually reviewed by a multidisciplinary team so the appropriate combination of treatments can be agreed.

Inflammatory bowel disease (IBD)

Inflammatory bowel disease describes long-term conditions that cause inflammation within the digestive tract. The two main forms are Crohn's disease and ulcerative colitis.

How can IBD affect people?

Symptoms can include diarrhoea, abdominal pain, urgency, bleeding, fatigue and weight loss. Symptoms often vary over time, with quieter periods and flare-ups. Crohn's disease can affect different parts of the digestive tract, while ulcerative colitis affects the large bowel and rectum.

How is it diagnosed?

Diagnosis is usually based on a combination of symptoms, blood and stool tests, endoscopy or colonoscopy, biopsies and imaging. These tests help establish the type and extent of inflammation and rule out other possible causes.

What treatment is available?

Many people are managed with medication under a gastroenterology team. Colorectal surgery may be considered when disease is not adequately controlled, when complications develop, or when surgery offers the best route to improving health and quality of life. The decision is individual and is usually made collaboratively between the patient and specialist teams.

Piles (haemorrhoids)

Haemorrhoids, often called piles, are vascular cushions in the anal canal. Everyone has this tissue, but it can enlarge or move downwards and then cause symptoms.

What symptoms can haemorrhoids cause?

Common symptoms include bright red bleeding, itching, irritation, mucus, discomfort or a lump that appears around the anus, particularly after opening the bowels. Internal and external haemorrhoids can behave differently, so an examination helps confirm what is causing the symptoms.

Why do they become troublesome?

Repeated straining and increased pressure in the area can contribute. Constipation, pregnancy and heavy lifting are among the circumstances associated with symptomatic haemorrhoids. Importantly, rectal bleeding can have several causes, so it should not automatically be attributed to piles.

How are haemorrhoids treated?

Treatment depends on the type and severity of symptoms. Measures to improve stool consistency and reduce straining are often important. If symptoms continue, the first treatment strategy would usually be outpatient haemorrhoid banding. If this is unsuccessful, Katie performs Doppler-guided haemorrhoidal artery ligation and rectopexy, and also trains other consultants in the technique. This is a useful treatment option designed to reduce the pain normally experienced following formal haemorrhoidectomy.

Colonoscopy

A colonoscopy is an examination of the large bowel using a thin, flexible camera passed gently through the anus. It allows the lining of the colon to be viewed directly.

Why might I need a colonoscopy?

It can be used to investigate rectal bleeding, changes in bowel habit, abdominal symptoms, iron-deficiency anaemia or an abnormal bowel cancer screening result. It can also be used to look for inflammation, ulcers, polyps and other abnormalities.

What happens during the procedure?

The bowel needs to be emptied beforehand using bowel preparation so that the lining can be seen clearly. During the procedure the camera is guided around the colon. Biopsies can be taken if required and many polyps can be removed at the same time. The exact preparation, comfort options and aftercare are explained before the test.

Are there alternatives?

For some patients, alternatives such as CT colonography may be considered. Different tests have different strengths and limitations, and a camera test may still be required if another investigation finds something that needs biopsy or removal.

Endoscopy

Endoscopy is a general term for examining the inside of the digestive tract with a camera. The endoscope is a thin, flexible instrument with a light and camera that sends images to a screen.

What kind of endoscopy might be used?

Lower gastrointestinal endoscopy includes procedures such as colonoscopy and flexible sigmoidoscopy. Katie also performs OGD (oesophago-gastro-duodenoscopy), sometimes called gastroscopy, which examines the oesophagus, stomach and the first part of the small bowel (duodenum). The exact examination depends on the symptoms and the reason for the investigation.

When is OGD particularly useful?

OGD can be particularly useful when investigating iron deficiency anaemia, because it can help identify or rule out possible upper gastrointestinal causes. It may also be used when investigating abdominal pain where an upper gastrointestinal cause needs to be considered.

What can endoscopy show?

Endoscopy can help identify inflammation, bleeding, ulcers, polyps, narrowing, tumours and other changes in the lining of the digestive tract. It also allows biopsies to be taken, and some findings may be treated during the same procedure.

Will it be uncomfortable?

People's experience varies. The clinical team will explain how the procedure is carried out and what options are available to help with comfort. The aim is that you understand what is being proposed and have the opportunity to ask questions beforehand.

Bowel cancer screening

Bowel cancer screening aims to identify signs that may indicate bowel cancer or pre-cancerous polyps before a person necessarily has symptoms.

How does screening work?

In the UK, bowel screening commonly begins with a faecal immunochemical test (FIT), which looks for tiny amounts of blood in a stool sample. Screening programmes and eligibility can change over time, so the invitation and instructions you receive from the NHS programme should be treated as the current guidance.

What if my screening result needs further investigation?

An abnormal screening result does not mean that you definitely have cancer. It means that further assessment is appropriate. Depending on the result and your individual circumstances, this may involve a specialist consultation and often a colonoscopy so the bowel can be examined directly.

Why is screening useful?

Some bowel cancers and polyps do not cause obvious symptoms in their early stages. Screening creates an opportunity to find changes earlier, and polyps identified during colonoscopy can often be removed before they develop further.