Anal bleeding, Piles, Thyroid nodules.
People are often referred to a surgeon when they have anal bleeding. When the blood is mixed with the stool, it usually means the bleeding originates from higher up in the colon and needs to be evaluated by colonoscopy. Click for more on colonoscopies.
Bleeding from the anus itself is usually seen as bright red blood on the toilet-paper and in the toilet-bowl after a bowel movement.
By far the most common cause for this is hemorrhoids, also known as piles.
What exactly are piles?
We all have little mucosal, gut lining, bulges 2cm deep in the anal canal. These bulges are called anal cushions and when these anal cushions enlarge, they form piles. Piles contain many fine blood vessels, which is why they can so easily bleed.
Why would I get piles?
Usually there’s no identifiable reason. Sometimes it’s the result of a person who spends too long sitting on the toilet or because of chronic constipation.Piles are also common during pregnancy because the enlarging uterus presses on the pelvic blood vessels, causing congestion in the veins in the anal cushions. This may lead to anal cushion engorgement and pile formation. Of course, the piles usually disappear shortly after the pregnancy is over.
What are the treatment options for piles?
Small piles often disappear by themselves, so often it’s more a case of reassuring you that there’s nothing more serious causing anal bleeding.
Bigger piles may be banded. This is when a small rubber band is placed around the pile causing it to fall off. Even bigger piles may be managed by ligation, which cuts off the blood vessels supplying them.
However, even larger piles may need to be surgically removed or a stapled hemorrhoidectomy performed.
Each procedure has it’s own indication and possible complications, so the treatment of piles need to be tailor-made for you by your surgeon.
I suffer from anal pain. Is this also caused by piles?
Seldom. Usually anal pain is caused by a non-healing tear in the lining of the anal canal. This is called an anal fissure, but there are numerous other conditions that can give rise to anal pain and discomfort.
The best is to have it checked out and a surgeon is the right person to ask.
Appendicitis is one of the most common emergency conditions managed by a surgeon.
What are the signs of appendicitis?
Usually there’s a sudden onset of abdominal pain starting around the navel and moving to the lower right abdominal wall. With this pain comes nausea and a loss of appetite. When inflammation of the sac lining the abdominal cavity occurs immediately over the appendix, this is called peritonitis and it’s a tell-tale sign that there’s underlying appendicitis. Appendicitis can also present in a less obvious way, which will result in you having an ultrasound scan and even a CT scan.
How is the appendix removed?
This can be done either by a small cut in your lower abdomen or laparoscopically. Your surgeon will decide which approach will be best for you.
Will everything be okay once the appendix is out?
Usually, yes. However, you need to remember that with any surgery there may be complications, even after a small operation like appendix removal. Once the appendix is out you should start feeling better and be back to normal in 2 – 3 weeks. If you don’t gradually improve you’ll need to be seen by your surgeon.
A single enlarged nodule in the thyroid gland is often the reason that you’ll be referred to a surgeon. More often than not, a piece of tissue from the thyroid gland needs to be removed. The tissue gets sent to a pathologist for evaluation to ensure it’s not cancerous.
Is surgery always necessary?
No. If there are other nodules in the thyroid, it may just be a bigger nodule as part of a multinodular goitre. An ultrasound scan can go a long way to exclude cancer, so can removing a few cells from the nodule during a small procedure. However, if any doubt remains, a partial thyroid removal will be needed as it can be quite difficult for the pathologist to differentiate between a normal thyroid and certain types of thyroid cancer.
Are there any risks associated with thyroid surgery?
There are risks associated with all types of surgery. In the case of thyroid removal, your surgeon will need to take special care not to injure the fine nerves running to your voice box. Your surgeon also needs to be careful not to damage the blood supply to your parathyroid glands, which are miniscule glands sitting immediately behind the thyroid and are crucial for calcium metabolism. As with any procedure, your surgeon will discuss these risks with you prior to performing the operation. Click for more on informed consent .