The London Rectal Clinic


Abdominal Hernia 
A hernia is the protrusion of abdominal contents through the abdominal wall.  Hernias may occur in one of a number of sites and have different causes.  They always contain a portion of peritoneal sac and may also contain other material.  Most require early surgical intervention.

Alimentary Canal 
Gastro-intestinal tract or digestive system.  The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and collects the waste until it passes out of the body.  The digestive system is made up of the oesophagus, stomach, and the small and large intestines. The last 6 feet of the intestine are called the large bowel or colon.  The last 6-8 inches of the colon make up the rectum, ending at the anus (the opening of the rectum to the outside of the body).

Anaesthesia / Anaesthetic 
An anaesthetic is used to temporarily reduce or take away sensation, usually so that otherwise painful procedures or surgery can be performed. There are two types of anaesthetics: general, which make the patient unconscious; local, which numb the part of the body that would otherwise feel pain. Anaesthesia-induced sleep is not the same as ordinary sleep but a form of temporary unconsciousness that is carefully controlled by the anaesthetist. This involves administering the right quantity of anaesthesia for each kind of operation.  Throughout the procedure, different types of medicines are added or removed to relieve the pain and maintain the right level of unconsciousness.  For some operations, the best option is to combine a local anaesthetic such as spinal or epidural anaesthesia, with medicines to make the patient sleepy. The anaesthetist can explain these details in advance. Anaesthetics are extremely safe; a recent survey it found that there are about five deaths for every million anaesthetics given.

A consultant anaesthetist is a specialist doctor who, after qualifying in medicine, spends about six years training in the specialty of anaesthesia.  Patients admitted to hospital for a surgical procedure will meet the Consultant Anaesthetist before and after operation, when they can ask any questions.

Relating to the anus

Anal fissure 
A tear or ulcer in the lining of the anal canal.  It can be very painful, especially when opening the bowel.

Anal lesions 
A term used to describe any damage to the anus.  Lesions may occur due to local infection, inflammatory bowel disease, sexually transmitted disease, trauma or cancer. They normally present with pain and bleeding. Thorough investigation is required to ascertain the cause of any lesion.

Anal polyps 
Small, benign, mushroom like growths occurring in the mucous membrane lining the anus. They can easily be removed if they become troublesome, or for pathological investigation, to eliminate more serious disease. Some benign anal growths are known as skin tags.

Anal sepsis 
Sepsis, or infection, may cause abscesses or fistulae. Diagnosis can usually be made using ultrasound and MRI scans.

Anal warts 
Or anogenital warts present as small lumps that develop on the anus and genitals. They are caused by a virus passed on during sex. They are treated by the application of a chemical, or by freezing.

Refers to disease that may occur in the rectum and the anus. This could be inflammatory bowel disease, or may be due to a malignant growth (cancer).  People often delay seeking treatment due to embarrassment or fear of cancer, which can allow the disease to progress.

Distal opening of the alimentary tract, through which solid waste matter (faeces), are expelled.

s the trade name of a toxin produced by the bacterium Botulinum.  Best known for its cosmetic use, Botox works by blocking the action of muscles.  Its many medical uses include the relief of painful muscle spasms, or relaxation of the anal sphincter muscle.

Is the abnormal growth of cells.  It can occur in any part of the body. It is known as malignant because it is harmful if untreated.

Colon or Colorectal cancer 
Commonly known as bowel cancer, is any cancer that affects the last section of the digestive system. This usually means the colon (large bowel) or rectum (back passage).  Colon cancer is caused by the abnormal growth of cells in the lining of the bowel.

A small flexible tube, about as thick as a finger, used to look inside the rectum (back passage) and colon (large bowel).

A procedure to look at the lining of the rectum and colon.  The bowel is a large tube with bends in it.  A colonoscope is passed into the rectum, to look at the lining of the bowel.  Some air will be introduced into the bowel during the examination, to make it easier to see.

Colonoscopy (virtual) 
Also known as CT colonography. It is less invasive procedure than a standard colonoscopy and therefore more patient friendly as a screening tool.

Refers to the study of the colon, rectum and anus and the diseases affecting them.

Refers to the area including the colon and rectum and abnormalities occurring in these organs.

Can be used to treat topical conditions and relieve itching or soreness.  A cream may be recommended for its soothing qualities or may contain medication.

Crohn’s Disease 
Is a condition that causes inflammation of the gastrointestinal tract (gut).  It can affect any part of the gut, however, it most commonly occurs at the lower end of the small intestine, known as the ileum. Typical symptoms include, pain and diarrhoea.  Daily medication can be taken to relieve the symptoms but sometimes surgery, to remove part of the gut, may be required.  

Digestive System 
See Alimentary Canal
Diverticular Disease / Diverticulitis / Diverticulosis 
s a digestive disease particularly affecting the large intestine. Diverticulosis involves the formation of pouches (diverticula) on the outside of the colon.  Diverticulitis results if one of these diverticula becomes inflamed.

Family History 
The occurrence of cancer within members of a family, which may, or may not, pre-dispose the patient to cancer.

Fissure /Fissure in Ano 
see Anal Fissure above

Fistula in ano 
Is an opening between the anus and rectum.  Anal fistula usually occurs as a result of an infection or an abscess (collection of pus) in the anus.  It can also be caused by conditions that affect the bowel such as inflammatory bowel disease.

Are tongues of tissue, (skin and subcutaneous tissue, sometimes including muscle,) cut away from the underlying parts but attached at one end. They retain their own blood supply during transfer to the new site.  They are used in surgery for filling a defect in a neighbouring region.

Flexible Sigmoidoscopy 
A procedure to look inside the rectum and lower part of the bowel using a narrow, flexible, tube-like telescope called a sigmoidoscope. It is routinely done as an out-patient procedure and does not require an anaesthetic or sedation. A sigmoidoscopy is used to find out the cause of symptoms such as changes in bowel habit or rectal pain. It is also used to check for inflammation, early signs of cancer and polyps. During the procedure, one or more biopsies (tissue samples) may be taken, for examination in a laboratory.  If necessary, it is possible to remove polyps and treat haemorrhoids during the procedure.

Gastrointestinal Tract 
See Alimentary Canal

Commonly known as piles, are swellings that develop in the anus and lower rectum (back passage). The small veins (blood vessels) in the lining of the anus and lower rectum sometimes become enlarged and engorged with more blood than usual. These engorged veins and the overlying tissue may then form into one or more small swellings called haemorrhoids.  There are 4 grades of severity. In many cases, haemorrhoids are small and symptoms settle down without treatment.  The commonest symptom is bleeding when opening the bowel. Larger haemorrhoids may cause itchiness, pain and a mucus discharge, which may cause irritation. Treatment varies according to the severity but principally involves changes in diet, possibly with medication, to avoid constipation; topical application of cream or ointment, or use of suppositories to relieve symptoms.

Haemorrhoid banding 
A common treatment for grade 2 and 3 haemorrhoids. The procedure is usually done by a surgeon in an outpatient clinic. A haemorrhoid is grasped with forceps or a suction device. A rubber band is then placed at the base of the haemorrhoid.  This cuts off the blood supply to the haemorrhoid, which then 'dies' and drops off after a few days. The tissue at the base of the haemorrhoid heals, with some scar tissue.

Banding of internal haemorrhoids is usually painless, as the base of the haemorrhoid originates above the anal opening, where the gut lining is not sensitive to pain.  Up to three haemorrhoids may be treated at one time using this method.

An operation, under general anaesthetic, to cut away the haemorrhoid(s) is an option to treat grade 4 haemorrhoids, and for grade 2 and 3 haemorrhoids not successfully treated by banding. The operation is is usually successful, however, it may be quite painful in the days following the operation.

Haemorrhoid Injection 
Phenol Oil is injected into the tissues at the base of the haemorrhoids. This causes a fibrotic (scarring) reaction which obliterates the blood vessels going to the haemorrhoids. The haemorrhoids then 'die' and drop off, in a way similar to banding. Other methods use heat to destroy the haemorrhoids including: infrared coagulation; photocoagulation; diathermy; electrotherapy. However, none of these procedures are as widely used as banding because their success rate is not as good.

Haemorrhoid Ligation 
A procedure in which the small arteries that supply blood to the haemorrhoids are ligated (tied).  This causes the haemorrhoids to shrink, it is not usually painful and is gaining in popularity as a treatment option.

A thin, bendy microscope with a light on the end.  It can be used to look inside the abdomen, take tissue samples (biopsy) and even carry out small operations (known as keyhole surgery). The images picked up by the laparoscope are displayed on a television monitor so that the surgeon can easily see what is happening.

Laparoscopic appendicectomy 
Removal of the appendix, through a keyhole incision, using images from a laparoscope for guidance.

Laparoscopic cholecystectomy 
Removal of the gallbladder, through a keyhole incision, using images from a laparoscope for guidance.

Laparoscopy is a procedure used to look inside the abdomen. It can help to identify and diagnose a range of conditions, including appendicitis and ovarian cysts. A small cut (incision) is made in the abdominal wall and a laparoscope is passed through it into the abdomen. A laparoscopy may be used to investigate symptoms such as abdominal pain, pelvic pain, or swelling in this area.  Sometimes, a laparoscopy is carried out if a previous test, such as an X-ray, or scan, has indicated a problem.

Lateral sphincterotomy 
An operation to divide part of the internal muscle in the anal canal. This relieves the pain associated with a fissure and allows the fissure to heal.  Healing will usually occur within two to four weeks.

A cancerous tumour that can invade and destroy nearby tissue and spread to other parts of the body.

Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body.

The medical speciality dealing with the diagnosis and treatment of cancer.

A doctor, who specialises in the diagnosis and treatment of cancer.

A doctor, who specialises in looking at cells and tissues using a microscope.  They are also referred to as cytologists (specialising in cells) or histopathologists (specialising in tissue).

Refers to the area known as the perineum.

Is the surface area between the legs, from the pubic region to the coccyx (tail bone). It includes the anus and, in females, the vagina. It can refer to the superficial structures only, or it can be used to include the deep structures.

Refers to the area in the abdominal and pelvic cavities lined by the peritoneum – the  peritoneal cavity.

A thin membrane lining the abdominal and pelvic cavities, which covers most abdominal organs and holds them in place.  It is composed of layer of mesothelium supported by a thin layer of connective tissue.

Inflammation of the peritoneum.  This can occur as a result of disease of an organ in the peritoneum, such as appendicitis.

Pilonidal sinus 
A small hole or sinus in the skin, usually at the very top of the cleft between the buttocks (natal cleft).  The sinus become filled with particles of skin and hair, and infected with bacteria.   If the sinus becomes blocked, it can get bigger, eventually forming a tunnel under the skin, filled with pus.  This is known as a draining sinus, or abscess.

An abnormal growth of tissue projecting from a mucous membrane. Polyps may  occur anywhere in the body where mucous membranes exist and are commonly found in the small intestine, stomach, colon, bladder and uterus.

Removal of polyps. Small polyps can be removed, through a coloscope, by an instrument called a biopsy forceps, which snips off small pieces of tissue. Larger polyps are usually removed by putting a noose, or snare, around the polyp base and burning through the tissue with electric cautery.  Neither of these procedures is painful,and the patient is not usually aware that they are being done.  Polypectomy is very safe, rarely is a polyp too large to remove via colonoscopy.

An instrument, consisting of a short tube or speculum equipped with a light, used to examine the rectum.

Internal inspection of the rectum through a proctoscope.

Pruritis ani 
Itching around the anal area. This is a common condition, which results in an irresistible urge to scratch. It may be most noticeable and bothersome at night or after bowel movements. Several factors may be at fault. Cleanliness is almost never a factor.  However, the natural tendency once a person develops this itching is to wash the area vigorously and frequently with soap and a washcloth.  This almost always makes the problem worse, by damaging the skin and washing away protective natural oils. A common cause is moisture around the anus, from excessive sweating or from moist, sticky stools. In some people, a loose and/or irritating stool may be caused by certain food or drinks, or high intake of liquids.

A doctor who specialises in interpreting x-rays, and ultrasound images.

A doctor specialising in treating disease using radiotherapy.

A painless form of high energy x-ray treatment used to destroy cancer cells, carried out by a Clinical Oncologist/ Radiotherapist.

Is found at the distal end of the alimentary canal, lying between the sigmoid colon and the anus.  It is about 6-8 inches long and is part of the body's digestive system.  It acts as a store for solid waste, or faeces, prior to expulsion.

Relating to the rectum.

Rectal biopsy 
Is the removal of a small piece of rectal tissue for examination. A rectal biopsy is used to determine the cause of abnormal growths found during proctoscopy,sigmoidoscopy, or other tests.

Rectal bleeding 
Refers to the presence of bright red blood on, or in, a bowel movement, on the toilet paper after wiping, or in the water of the toilet bowl.  It is a common problem for people of all ages.

Rectal Cancer 
A disease in which malignant (cancerous) cells form in the tissues of the rectum. 

Rectal prolapse 
Is the protrusion of either the mucous membranes or the entire wall of the rectum. Partial prolapse involves only the mucosa and usually only protrudes by a few centimetres. Complete prolapse involves all layers of the rectal wall. In the earliest phases of this condition, the rectum does not stick out of the body, but as the condition worsens, it may protrude. There are various causes of rectal prolapse, however, in most cases, no single cause can be identified.

The partial removal of an organ. This may be undertaken for cancer, inflammatory bowel disease or trauma.  In many cases, when a section of bowel is removed, to eradicate the diseased tissue, the two cut ends of the bowel can be joined together.  In some instances one end of the bowel is brought to the surface, as a colostomy or ileostomy, depending whether the resection occurs in the large or small bowel. The waste or faecal matter is then passed into a small plastic bag.  Sometimes the procedure can be reversed, after a period of time, enabling the bowel to rest and heal.

Rotational flaps 
Are local flaps that use adjacent tissue rotated in an arc, to close a defect. They provide the ability to mobilise large areas of tissue with a wide base and thus an excellent blood supply for reconstruction. 

Scans are pictures of structures inside the body.  Scans commonly used in diagnosing, staging, and monitoring disease include: liver scans; bone scans; and computed tomography (CT) or computerised axial tomography (CAT) scans; magnetic resonance imaging (MRI); and Ultrasound scans.  In liver and bone scanning, radioactive substances injected into the bloodstream collect in these organs.  A scanner, which detects the radiation, is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body.

Is the medical examination of the large intestine from the rectum through to the distal part of the colon.  There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope, and rigid sigmoidoscopy, which uses a rigid device.  Flexible sigmoidoscopy is today generally the preferred procedure. Sigmoidoscopy is a very effective screening tool, it is similar to but not the same as colonoscopy.  Sigmoidoscopy only examines up to the sigmoid, the most distal part of the colon, while colonoscopy examines the whole large bowel.

Stapled haemorrhoidectomy 
A procedure in which a circular stapling 'gun' is used to cut out a circular section of the lining of the anal canal above the haemorrhoids.  This has the effect of pulling the haemorrhoids back up the anal canal.  It also reduces the blood supply to the haemorrhoids, which shrink as a result.  Because the 'cutting' is actually above the haemorrhoids, it is usually a less painful procedure than the traditional operation to remove the haemorrhoids.

An abnormal mass of tissue that results from excessive cell division. Tumours perform no useful bodily function. They may be benign (not cancerous) or malignant (cancerous).

Ulcerative Colitis 
Is a long-term (chronic) condition affecting the colon.  Conditions that cause inflammation of the intestines, such as ulcerative colitis or Crohn's Disease, are known as inflammatory bowel disease (IBD). This should not be confused with irritable bowel syndrome (IBS), which is a different condition and requires different treatment.  Ulcerative Colitis causes the colon to become inflamed, and in severe cases, ulcers may form on the lining of the colon. These ulcers can then bleed and produce mucus and pus.  Symptoms of ulcerative colitis include: a frequent need to open the bowels; diarrhoea, often with blood in it; abdominal pain; and weight loss.  Symptoms can vary from mild to severe, so for some people the condition is a minor inconvenience, while for others it can seriously impact on their quality of life.  Ulcerative colitis is an unpredictable condition, symptoms can flare up, and then go into remission for months, or even years.  The causes of the condition are unknown, though research suggests that both environmental and genetic factors are involved.

High frequency sound waves, which are converted into an image of the tissues.  Ultrasound may be used as a diagnostic tool, or as an additional investigation.

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