Patient Information

An abscess is a collection of pus in any localised space in the body. An anal abscess is one that develops in the tissues around the anus. These abscesses can cause pain, swelling, and redness, and may require medical treatment to drain the pus and clear the infection.

An anal fistula is an abnormal tunnel that forms between the internal lining of the anus and the skin outside the anus. It can develop after the drainage of an anal abscess or occur spontaneously. The discharge of pus from a fistula may be constant or intermittent, as the external opening on the skin can temporarily heal and then reopen.

A fissure is a split or tear in the skin of the anal canal. When this split fails to heal, it can develop into a painful ulcer. This condition is often associated with spasms of the anal sphincter muscle, which can exacerbate the pain and delay healing.

Bowel cancer is an abnormal growth of cells lining the bowel, forming a lump known as a malignant tumour. These cancer cells can spread from the primary site in the bowel to lymph glands or other organs, creating clusters called metastases or secondary cancer. The vast majority of bowel cancers affect the large bowel (colon and rectum), while the small bowel is rarely involved.

A cholecystectomy is a surgery to remove the gallbladder. The gallbladder is a pear-shaped organ that sits just below the liver on the upper right side of the abdomen. The gallbladder collects and stores a digestive fluid made in the liver called bile.

A cholecystectomy is a common surgery. It is a safe operation and usually carries only a small risk of complications. In most people this surgery is done using small incisions, this is called a laparoscopic cholecystectomy.

In some cases, one large incision may be used to remove the gallbladder. This is called an open cholecystectomy.

A colonoscopy is a procedure used to diagnose and treat various issues in the colon (large bowel or large intestine). It involves using a colonoscope, a flexible tube, which is inserted through the rectum into the colon. This allows the doctor to examine the bowel lining in detail.

Colonoscopy is gold standard and can identify abnormalities too small to be seen on ct colonography. If a suspicious area is found or further evaluation is needed, the doctor can take a tissue sample (biopsy) through the colonoscope for laboratory examination. Biopsies are taken for many reasons and do not necessarily indicate cancer.

Constipation is a very common condition that affects almost everyone at some point. It can mean different things to different people. For some, it refers to the passage of hard stools, while for others, it means infrequent bowel movements. Some people believe it’s essential to have one bowel movement every day, but the normal range of bowel frequency can vary from three times a day to once every three days.

Crohn’s disease is a chronic inflammatory condition that typically affects the small and/or large bowel. The exact cause is unknown, but there are many theories, including genetic, environmental, and immune system factors. Symptoms can vary widely but often include abdominal pain, diarrhoea, weight loss, and fatigue. Managing Crohn’s disease usually involves medication, lifestyle changes, and sometimes surgery to control inflammation and maintain remission.

Diverticular disease is a benign (non-cancerous) condition of the colon, also known as diverticulosis. It involves small pockets (diverticula) that bulge out of the colon through its muscle wall. When these pockets become inflamed, the condition is called diverticulitis. Symptoms of diverticulitis can include abdominal pain, fever, and changes in bowel habits. Treatment often involves dietary changes, medications, and in some cases, surgery.

Endometriosis is a systemic disease characterised by the presence of endometrial tissue outside the uterus. It can cause a wide range of symptoms, including pain, dyspareunia (painful intercourse), infertility, and menstrual irregularities. Bowel symptoms such as bloating, changes in bowel habits, tenesmus (sensation of incomplete evacuation), rectal bleeding, or difficulty evacuating can occur, especially with advanced pelvic disease.
Surgically, endometriosis can be found anywhere in the abdominal cavity, most commonly in the pelvis. Extra-pelvic sites include the abdominal wall, scars, umbilical and inguinal regions, and even the chest wall lining and lungs. Treatment options include medical and surgical therapies. Surgery, often performed by a gynaecologist using laparoscopic or robotic approaches, is recommended for deeply invasive disease, patients unresponsive to medical treatment, or those desiring fertility.
Colorectal involvement depends on the extent of the disease and the surgeon’s experience. Surgical options include shaving, disc resection, or segmental resection of the rectum or colon. The choice of procedure should be individualised, with segmental resection preferred for colorectal disease. A conservative approach to resection is recommended, and stoma rates can vary based on experience, disease extent, and previous surgeries.

Faecal incontinence is the inability to control the passage of faeces or gas from the anus. It can range from severe, with major accidents, to minor, with streaking or smearing of underwear. Incontinence may occur daily or at irregular intervals, often making cleaning difficult and necessitating the use of pads.

Faecal urgency is the inability to delay bowel movements, requiring immediate access to a toilet. While accidents may not always occur, the urgency can be disabling. Both faecal incontinence and urgency can significantly impact a person’s quality of life, leading to social isolation, work challenges, and disruptions in personal relationships.

A gastroscopy allows examination of the upper part of your digestive tract i.e. oesophagus (food pipe), stomach and duodenum (top section of the small intestine), by passing a gastroscope (long, flexible tube with a camera on the end) through your mouth and down your digestive tract.

If a suspicious area is found or further evaluation is needed, the doctor can take a tissue sample (biopsy) through the gastroscope for laboratory examination.

Haemorrhoids, often referred to as “varicose veins” of the anal canal, are actually swollen blood vessels covered by the lining of the anal canal. Most haemorrhoids start as internal and are not visible. However, as they enlarge, they bulge into the anal canal and may eventually protrude through the anus (prolapse). This can sometimes lead to the formation of an anal skin tag due to the stretching of the skin.

A hernia exists where part of the abdominal wall is weakened, and the contents of the abdomen push through to the outside. This is most commonly seen in the groin area but can occur in other places. Surgical treatment is usually quite straightforward and involves returning the abdominal contents to the inside and then reinforcing the abdominal wall in some way.

The commonest hernias are usually those in the groin (inguinal/ femoral) and hernias that occur after previous surgery (incisional hernias).

Many people experience recurring gastrointestinal symptoms that can be attributed to irritable bowel syndrome (IBS). Your bowel function is closely linked to your life events, and changes in stress levels, travel, and diet often lead to alterations in bowel habits. Common symptoms include abdominal bloating, colicky pain, diarrhoea or constipation, and intermittent mucus discharge. Spasms of the pelvic floor muscles, causing rectal pain, are also common in IBS patients.

Many individuals worry about more serious conditions, such as bowel cancer, but reassurance and explanations from their doctor can often alleviate some IBS symptoms. A family history or a long-term history of various symptoms can help doctors diagnose IBS. It’s important to note that bleeding from the bowel is never caused by IBS and should always be checked by a doctor.

What does a polyp look like?

Polyps vary in their shape, size and location within the large bowel. They may be single or multiple. A typical polyp has the appearance of a cherry with a short stalk or pedicle. Most polyps measure about one centimetre in diameter. Some have no stalk and are flat or carpet-like, spreading over the mucosal surface of the bowel.

Adenomatous polyps (adenoma)

There are different varieties of polyps but those which are associated with bowel cancer are termed adenomatous polyps or simply adenomas. This variety of polyp is important because there is strong evidence that some adenomas may undergo malignant change to produce bowel cancer. Patients who are found to have adenomas are considered at risk of developing bowel cancer. This risk is difficult to quantify. It varies from patient to patient and usually requires periodic surveillance by telescopic examination of all of the large bowel (colonoscopy).

Pre-cancer and cancer

Adenomas when pre-cancerous are composed of abnormal, rapidly dividing cells whose suspicious appearance and behaviour can only be accurately recognised by the pathologist when examined under the microscope. Therefore, when polyps are discovered they are best removed (polypectomy) so that they can be carefully examined and classified by a pathologist. It may take up to 12 years for a benign adenoma to become an invasive cancer. Large adenomas (greater than two centimetres in diameter) are always suspected of having developed a small focus of cancer until proven otherwise by the pathologist.

Symptoms

Although polyps are very common, they rarely produce symptoms and usually are discovered by chance at the time of colonoscopy. However, large adenomas occasionally may cause bleeding , usually as blood mixed in the stool.

Who is at risk?

People who have suspicious bowel symptoms (especially bleeding) and are approaching 40 years of age or older, may need a colonoscopic examination. Other people at risk include those with a significant family history of one or more first degree relatives (mother, father, sister, brother or child) who have had bowel cancer. Patients who have had a previous adenoma or cancer successfully treated, have a risk of developing polyps which continues through their life. Familial adenomatous polyposis (fap) is a rare, inherited disorder in which some members of the family will develop hundreds of polyps ultimately causing bowel cancer if not treated properly.

Treatment

Colonoscopy is the most accurate test to diagnose polyps. The purpose is to obtain a clear view of the whole length of the inner surface of the bowel, to search for and remove any polyps found, and have them examined under the microscope. Up to 90% of polyps can be safely and completely removed by colonoscopy.

Future checks

If adenomas are confirmed by a pathologist, it is recommended that the patient have regular “check-ups” by repeated colonoscopy. The frequency of examinations varies and this needs to be discussed with the doctor who performed the colonoscopy.

Definition

The word polyp refers to any visible structure which projects from the lining of the inner (mucosal) surface of the bowel wall. A polyp typically has the appearance of a small, warty outgrowth.

Proctitis is an inflammatory condition affecting the inner lining (mucosa) of the rectum, the lowest part of the large intestine. It affects both males and females equally, and no age group is excluded. The exact cause of proctitis is unknown. Most cases are part of the spectrum of chronic inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease. Other cases may be due to infectious agents, some of which can be sexually transmitted. Inflammation following radiotherapy to pelvic organs is another cause of proctitis, known as radiation proctitis.

The skin around the anus is sensitive and can be difficult to keep clean. Seepage of faeces and moisture are common factors that contribute to this condition. Hair near the anus can aggravate the problem. The skin becomes irritated, causing itchiness, and the urge to scratch leads to skin damage, further irritation, and a persistent cycle. Several common conditions, such as allergies, diabetes, and inflammatory bowel disease, can affect the skin around the anus, causing pruritus. Haemorrhoids with associated mucus discharge may also contribute to this issue.

Rectal bleeding refers to any blood that passes from your anus.

Rectal bleeding may show up as blood in your stool, on the toilet paper or in the toilet bowl. Blood that results from rectal bleeding is usually bright red in colour but occasionally can be dark colour.

Common causes for rectal bleeding include anal fissure, constipation and haemorrhoids.

If you experience rectal bleeding, it is important to seek advice from your GP or specialist promptly.

A prolapse occurs when part of the bowel protrudes through and outside the anus. Possible causes include excessive straining during defecation, weak pelvic floor and anal sphincter muscles, or insufficient fixation of the lower bowel (rectum) to nearby pelvic structures. Rectal prolapse is six times more common in women than in men, but it is not related to childbirth. It is also common in early childhood and usually resolves without surgery in this age group.

Males and females are equally affected and can present at any age. The cause is unknown, but many theories exist. It does not appear to be contagious or hereditary, although it is rare for more than one family member to have the condition. It is not caused by dietary factors but may follow an acute diarrheal illness.

Only the large bowel is involved, with inflammation starting in the rectum and extending variably towards the beginning of the large bowel (caecum). If the caecum is involved, it is called pancolitis, whereas if only the rectum is involved, it is called proctitis. Ulcerative colitis is comparable to a “burn” of the inner lining of the bowel (mucosa), resulting in inflammation and shallow ulceration, which causes diarrhoea, bleeding, and mucus. Over time, the patient may become anaemic and depleted of protein and salt.

For information on Coeliac Disease please visit the Coeliac New Zealand website: https://coeliac.org.nz/

For information on Endometriosis please visit the Endometriosis New Zealand website: https://nzendo.org.nz/