Conditions and Treatment Options
Colorectal (Bowel) Cancer:
Colorectal cancer or Bowel cancer is a common cancer in adults. Symptoms of bowel cancer include blood in the stool, a change in bowel habit (either change in frequency of motions or consistency of motions), abdominal pain or fatigue (which may indicate a low blood count- anaemia). However, it is important to note that most cancers are without symptoms in the early stages. Colonoscopy is the diagnostic test of choice. Screening should start from age 50 (unless there is a strong family history). Screening can be done by a Faecal Occult Blood kit (stool test) or colonoscopy. Bowel cancer has a very high cure rate if detected early and treated adequately by a trained colorectal surgeon who can work in a team with radiation and medical oncologists.
Bowel cancer risk is reduced by colonoscopy which allows polyps (precancers) to be removed before they can become cancer.
Inflammatory Bowel Disease:
Inflammatorty Bowel Diseases (Crohns Disease and Ulcerative Colitis) are best treated by a combination of gastroenterologists and Colorectal surgeons. In Crohns disease surgery may be required to remove part of the bowel if the diseased bowel failed to respond to medical management, obstructed, perforated, penetrated another organ (fistula) or uncontrollable bleeding. Surgery is also sometimes required for infection around the anus. In Ulcerative colitis when all medical treatment fails, then surgery can remove all of the rectum and colon and create a new rectum from the small bowel. All these surgical options are preferably performed laprascopically (keyhole) to minimise long term complications. Dr Kozman is fortunate enough to work closely with the Inflammatory Bowel Disease clinics at both St George and Bankstown Hospitals.
Diverticulitis is infection which occurs in pockets in the bowel. The severity of diverticulitis can range from very mild and settling with tablet antibiotics to major perforation requiring emergency surgery. Thankfully, the sever form is rare. Elective surgery is in indicated in recurrent attacks and narrowing disease.
Faecal incontinence is a common disorder, it is often undertreated due to embarrassment. Incontinence can arise for several reasons from loose stools, to a weak anal sphincter to rectal prolapsed disease. Successful outcomes are most commonly the result of multimodal treatment (medications, involvement of a pelvic floor nurse, and occasionally surgery). It is a treatable condition.
Haemorrhoids are normal, they are large veins which are designed to plug the anus when you’re not going to the toilet. Over time due to hard stools and other factors such as pregnancy and child birth, these veins can fall down (prolapse). If they prolapsed into the anus they are often referred to as internal haemorrhoids. If they prolapsed all the way out they are referred to as external haemorrhoids. Treatment is a combination of dietary changes (increased fibre and fluids) and intervention. Intervention options include rubber band ligation, Haemorrhoidal Artery Ligation, Stapled Haemorrhoidectomy, haemorrhoidectomy. The treatment choice is best discussed with your surgeon after examination.
Anal fissures are tears in the anal lining as a result of passing a hard stool. This leads to a tearing pain (sometimes described as passing a knife blade) on passing a motion. As a consequence of the fissure the internal sphincter muscle spasms resulting in the fissure not healing. Treatment involves softening the stools by increasing fibre and fluid intake. Ointments (GTN or Calcium Channel Blockers) help relax the sphincter and allow the fissure to heal, if this fails the BOTOX injection is used to relax the sphincter for a longer period. The last resort is surgery to partially cut the internal sphincter muscle.
Perianal abscess and fistula:
Inside the anus are anal glands, these glands may become infected and develop into an abscess (like a pimple). This abscess tracks towards the skin and creates a perianal abscess. If the path the abscess follows does not close then a fistula ensues. Surgery for this condition depends on many factors including : location (front or back), the amount of muscle involved in the fistula and patient continence.
Puritus ani (itchy bottom):
Purtus ani can be as a result of another pathology (most commonly haemorrhoids) or due to the skin. This condition is resolved by treating the cause and modifying behaviour (such as over exuberant cleaning, causing dry skin due to soap selection and excessive scratching). Various ointments may be of help. As a last resort, methylene blue is injected into the skin to numb the area.
Rectal prolapse is a condition when the rectum (the lower end of the bowel) turns inside out. This may just be the lining (mucosal prolapse) or the entire rectum (full thickness prolapse). The cause of the prolapse may be chronic straining when going to the toilet, weakened pelvic floor (in post menopausal women) or most commonly, a combination of both. Surgery is needed for full thickness external prolapsed. This may be preformed from the abdomen (usually laprascopically or robotically) or via the anus.
Constipation is a common problem which may be caused by slow movement of the bowel (either due to medications, age or genetics) or due to movement of the rectum causing obstruction, or a combination of both. It is mostly treated with lifestyle changes, stools softners, medications and rarely surgery. The involvement of a pelvic floor unit (available at both St George and Bankstown Hospitals) is often vital in the management of constipation.
A hernia is a hole in the muscle which allows internal tissue to protrude through. Most commonly, hernias are in the groin (inguinal hernia) and occur in men. Where possible, laparoscopic repair is preferable as it results in a faster recovery and less risk of chronic pain.
Gallstones can result in pain and cause complications such as cholecystitis (inflammation of the gallbladder), blockage of the bile duct (choledocholithysis), infection of the bile duct (cholangitis) or pancreatitis. Removal of the gallbladder is a common operation which is safely perfomed laproascopically.