What I treat
- Internal and external haemorrhoids
- Anal fissure, acute and chronic
- Persistent anal itching
- Fistulas and abscesses, with surgical referral where appropriate
- Rectal bleeding, which must always be investigated and never attributed to haemorrhoids without checking
- Incontinence and difficulty evacuating, alongside anorectal manometry
The rule not to skip
Rectal bleeding is the symptom most often dismissed. It is true that haemorrhoids are the commonest cause, but it is also the first sign of rectal cancer, and haemorrhoids are so common that almost everyone has some to blame.
So bleeding is always investigated, even when haemorrhoids are visible, and all the more so above a certain age or with a family history.
Diagnosis and treatment at the same visit
Proctological examination and anoscopy are performed in the consulting room, with no special preparation. Many treatments, such as rubber band ligation of internal haemorrhoids, are applied in the same session, take minutes and require no admission or time off work.
Treatment
Most cases are resolved with conservative measures, topical treatment and correcting bowel habit, which is usually where the problem originates.
When more is needed, outpatient treatments such as band ligation are available. Surgery is reserved for cases that genuinely require it, which are fewer than those resolved with medical and endoscopic treatment.