Melbourne Haemorrhoid and Rectal Bleeding Clinic

Maurice Brygel | Peter Grossberg | Charles Leinkram | L. P. Cheah | Zeev Duieb |
Reassurance | Dietary Advice | Local Measures | Injection | Rubber Band Ligation | Surgery |
Anal Fissure | Abscess & Fistula | Polyps | Anal Cancer | Warts | Puritis Ani | Pilonidal Sinus
Colonoscopy | Gastroscopy |
Faecal Occult Blood | Diverticular Disease | Irritable Bowel Syndrome | Bowel Cancer | Ischaemic Bowel Disease | Ulcerative Colitis | Crohn's Disease | Genetics
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the ano-rectal region - a scientific approach (click here)

What are haemorrhoids?

Haemorrhoids can be likened to varicose veins. These are clumps of vessels which swell with any increase in pressure. Haemorrhoids occur equally in adult men and in women – particularly during pregnancy. They are thought to be associated with a lack of fibre in the diet and the undue straining this causes at toilet.

Haemorrhoids cause problems because they:

  1. bleed
  2. protrude
  3. clot and become very painful
  4. may itch

There are other causes for all these types of symptoms and it is important that if you have any of these symptoms seek medical attention from a General Practitioner or Specialist in this field – called proctology. As well as taking the history an examination of the area is compulsory. The clinic provides early or urgent access to a group of Specialist Physicians or Surgeons who are experienced in this field and Specialists in the appropriate tests or procedures, which may be required. An appropriate history and relevant tests will be expedited effectively and in a cost effective way.

For patients with haemorrhoids after examination, the treatments range from:

  1. reassurance, dietary advice
  2. local applications
  3. injection
  4. rubber band ligation
  5. surgery

 

Haemorrhoids are graded in severity. This gives a guide to the preferred method of treatment.

  1. bleed only – may respond to diet and local applications (occasionally injection if bleeding severe)
  2. prolapse with bowel movement but reduce spontaneously – suited for rubber band ligation
  3. need to be pushed back in and associated with large skin tags – rubber band ligation or surgery may be required
  4. permanently out – or thrombosed – very painful. Surgery may be required

 

Many people label any problem in the area as haemorrhoids or piles. It is important to distinguish other causes of:

  1. bleeding
  2. a lump
  3. pain
  4. irritation or discharge from other conditions of the bowel

Bleeding from other local causes may be:

  1. skin tags
  2. anal fissure
  3. anal fistula
  4. abscess
  5. ulcer
  6. polyps or cancer

 

Bleeding may be from higher up in the rectum or bowel from conditions such as:

  1. polyps
  2. cancer
  3. diverticular disease

These conditions can only be distinguished by the history and complete examination – the type of bleeding and the associated complaints may give an indication as to whether the condition is local or from higher in the bowel. For example the bleeding of haemorrhoids typically is bright red blood on the toilet paper and found to have spurted into the bowl with a bowel action. The blood is not usually mixed with the bowel action. Bleeding mixed with the bowel action suggests the source is higher in the bowel.

Other causes of a lump may be:

  1. skin tags
  2. anal or low rectal polyps
  3. a low cancer
  4. prolapse of the rectum
  5. an abscess, usually very painful
  6. fistula, usually associated with a discharge

Other symptoms which need to be considered are:

  1. abdominal pain
  2. change of bowel habits
  3. a sense of unsatisfied defecation (feeling like there is still something there)
  4. weakness or tiredness due to anaemia
  5. loss of weight

Examination:

An abdominal examination should be carried out first. This is followed by an inspection of the area, then a rectal examination. This is usually carried out with the patient lying on the side in the left lateral position. A gloved rectal examination is carried out unless there is a very painful condition obvious. Next a proctoscope or sigmoidoscope is inserted to examine the local area and the lower part of the rectum.

Flexible sigmoidoscopy and colonoscopy examine the bowel higher up or right around the whole large bowel. These procedures require prior arrangements and usually the use of a bowel preparation in a dedicated facility such as a day surgery centre.

Early Cancer Detection:

An important issue these days is cancer prevention. Surveillance, occult blood testing and  colonoscopy all play an increasing role in detecting polyps early before they become malignant. Also cancers can be detected before they have spread and maybe cured.

Conditions dealt with at this clinic and procedures, which may be carried out as appropriate, not necessarily at the time of the first visit are:

  1. sigmoidoscopy
  2. flexible sigmoidoscopy
  3. colonoscopy
  4. drainage of a perianal haematoma
  5. excision of a thrombosed haemorrhoid
  6. excision of skin tag
  7. injection of haemorrhoid
  8. rubber band ligation of haemorrhoids
  9. perianal abscess and ischio rectal abscess
  10. anal fistula
  11. pruritus ani
  12. anal warts
  13. rectal prolapse
  14. pilonidal sinus and pilonidal abscess

About the Clinic:

There is a Specialist in attendance each day. We undertake to see you within one week of contacting us, and if required on the same day. A Specialist Nurse is in full time attendance to answer your queries and advise you on the most appropriate way to attend. If necessary a doctor will discuss some of the issues with you over the phone within 48 hours.

It is preferable to have a referral from a Practitioner. If you are contacting us by email please allow two to three working days for a response. If you do not receive a response please contact us by phone or fax again.

Phone: +61 3 9525 9077 - email: mbrygel@netspace.net.au - fax +61 3 9527 1519