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SEO Friendly Title: Dr Stephen Brockman - Geelong Colorectal Surgeon

Stephen is a specialist general and colorectal surgeon who is a Fellow of the Royal Australian College of surgeons (FRACS) and a provisional member of the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). He is a member of Barwon Surgical group and operates and consults at St John of God Hospital, Geelong.


Your Surgeon

SEO Friendly Title: Dr Stephen Brockman

Stephen is a specialist general and colorectal surgeon and is a Fellow of the Royal Australian College of Surgeons (FRACS) and a provisional member of the Colorectal Surgical society of Australia and New Zealand (CSSANZ). Stephen was born and raised in Geelong where he completed his secondary education.

After graduating with a Bachelor of Medicine and Surgery at the University of Queensland, he trained in General Surgery at both the Royal Brisbane and Women’s Hospital and St Vincent’s Hospital, Melbourne. He then completed further training at the Austin Hospital in Melbourne and the Princess Alexandra Hospital in Brisbane in colorectal surgery through the internationally acclaimed Colorectal Surgical Society of Australia and New Zealand (CSSANZ) training program.

Stephen has completed Robotic Surgery Training in Sunnyvale, California as well as clinical observerships at The Cleveland Clinic in Ohio and Oklahoma Surgical Hospital.

He has a strong interest in surgical oncology (bowel cancer), inflammatory bowel disease (IBD), pelvic floor disorders including ventral rectopexy and sacral nerve neuromodulation (SNM), and minimally invasive surgery including Laparoscopic and Robotic surgery and trans-anal minimally invasive surgery (TAMIS).


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Patient Information: Anal Cancer

SEO Friendly Title: Anal Cancer

What is anal cancer?

Cancer occurs where normal cells in the body, through genetic changes, lose the ability to control and regulate growth. As cancers grow, they can invade tissue around them (local invasion). Through further genetic changes, cancers can also spread more widely, often first to local lymph nodes then to distant organs such as the liver or lungs. These are known as metastases or secondaries.
Anal cancers arise from cells at the anal opening (anal verge) or just within the anal canal. Most arise from squamous cells and are called squamous cell carcinomas (SCC).

How common is anal cancer?

Anal cancers are not common, making up just 1% of gastrointestinal cancers. The incidence is around 1 case per 100000 people.

Who is at risk of anal cancer?

Anal cancer is preceded by changes in the lining of the anus known as anal intraepithelial neoplasia (AIN). This is usually caused by infection with human papilloma virus (HPV), and is similar to the changes in the cervix (CIN) that lead to cervical cancer in women.
The risk factors for anal cancer include:

Can anal cancer be prevented?

Few cancers can be totally prevented but it is likely that vaccination against HPV virus will protect many people from developing anal cancer. Using condoms will not eliminate the risk but will reduce it. Stopping smoking will reduce the risk of many cancers including anal caner.

What are the symptoms of anal cancer?

Anal cancer is often diagnosed early when patients see their doctor with symptoms. The symptoms of anal cancer are not specific for anal cancer but should prompt a check up with the local doctor. These include:

How is anal cancer diagnosed?

Usually, a surgeon will organise a biopsy under an anaesthetic to confirm the diagnosis. If you have swollen lymph nodes in the groin, a biopsy using ultrasound guidance may also be performed. This will usually be followed by some tests to assess the cancer and see if it is localised to the anus. These may include an MRI, a CT scan and a PET scan.

What are the treatment options?

There are 3 types of treatment used for anal cancer; radiation, chemotherapy and surgery. Most cancers will be treated with a combination of radiation therapy and chemotherapy. Occasionally, a small cancer may be removed with surgery with a local excision. Sometimes surgery will be required after radiotherapy/chemotherapy if the cancer is still present or comes back.

Will I need a stoma?

Most patients treated with anal cancer will not need a stoma. For those patients who are not cured with radiotherapy/chemotherapy, removal of the anus and rectum with formation of a stoma will usually be required. This is known as abdomino-perineal resection (APR).

What are the prospects of cure?

Many patients will be cured of anal cancer with combination therapy with radiation/chemotherapy. Approximately 3 in 10 patients will need surgery after combination treatment. For patients that undergo surgery, approximately half will be alive 5 years after surgery.

What is the follow up after treatment?

Your surgeon will arrange a schedule of follow-up that will extend for many years after treatment of your cancer. This helps to identify problems that may arise and identify recurrent disease early. Follow up will include examination in the rooms and sometimes under anaesthetic, colonoscopy and imaging such as MRI, CT and PET scans.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Anal Fissure

SEO Friendly Title: Anal Fissure

What is a fissure?

An anal fissure is a split in the skin at the anal opening (verge). The split fails to heal and forms a chronic wound that leads to a spasm pain due to contraction of the sphincter muscle.

What is the cause of a fissure?

Most fissures are caused by local injury/trauma to the anus. Most often this is due to passing a hard bowel motion. Usually, the split in the skin will heal by itself. Sometimes, the split fails to heal and leads to a chronic fissure.

What are the symptoms of a fissure?

The wound leads to spasm of the underlying sphincter muscle. This causes an intense anal pain, especially after passing stool. The wound may also lead to bleeding especially on the toilet paper and occasionally an itch or discharge. Often, a swollen lump known as a skin tag will develop.

What is the treatment?

Many fissures can be healed with medical treatment. This involves a combination of stool softners, high fibre diet and topical treatment (creams) aimed at treating pain and relaxing the sphincter muscle.
Sometimes, the fissure does not heal with medical treatment. Surgical treatment options include botox injection, removing the fissure and closing the skin with a small flap, and dividing some of the sphincter muscle (lateral internal sphincterotomy). Your surgeon will explain to you the options and the risks and benefits of each treatment.

What are the results and complcations of surgical treatment?

The results of surgery are good. Healing may take many weeks but usually the pain should be better following surgery. Healing of the fissure can be expected in 75% of patients after Botox injection and 95% of patients after sphincterotomy. Complications are very uncommon. Following surgery, some patients will have some impairment in the ability to control wind. This will usually recover approximately 3 months after Botox but may be longer lasting after sphincterotomy. Incontinence to faeces is a very rare complication of surgery.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Anal Abscess/Fistula

SEO Friendly Title: Anal Abscess/Fistula

What is an anal abscess?

An anal abscess is a collection of pus in a cavity next to the anus.

What causes an anal abscess?

An anal abscess is usually due to blockage of an anal gland just inside the anus. Blockage of the gland leads to infection that can extend to different areas around the anus causing an abscess. The abscess may burst through the skin or be drained by a doctor.

What are the symptoms of an abscess?

An abscess usually causes constant pain around the anus. There may be a swollen tender lump and sometimes a fever or chills. If the abscess has burst, there will be some malodorous discharge (pus).

How is an abscess treated?

An abscess needs to be drained to prevent a more severe infection. Sometimes this can be done under local anaesthetic in the doctors office. A larger abscess may require drainage in an operating room by a surgeon. Antibiotics alone will not cure an abscess.

What is a fistula?

After an abscess has been drained or burst opened, a tunnel or tract between the wound and the anal gland may persist. A fistula usually develops after an abscess but may occur without an abscess.

What are the symptoms of a fistula?

A fistula causes chronic discharge that can lead to irritation around the anus. Symptoms include discharge, pain, itch and difficulty with hygiene.

Does an abscess always become a fistula?

No. A fistula develops in around 50% of patients following an anal abscess.

Is a fistula related to other diseases?

Sometimes. Most fistula are related to a previous abscess. Sometimes, patients with Crohn’s disease develop anal abscess and fistula.

How is a fistula treated?

Usually, the fist step in fistula treatment is to get control of the infection. This usually involves an examination in the operating theatre by a surgeon and insertion of a soft drain (Seton). Sometimes, your surgeon will recommend further tests such as a colonoscopy or an MRI scan. Once there is control of the infection, there are a number of options to treat the fistula including:

The best option for you will depend on your individual fistula anatomy, previous attempts at repair and the risks and benefits of the procedure.

How successful is treatment?

Fistula treatment can be particularly frustrating for patients as it can take multiple attempts at repair before it is fixed. The treatment with the highest success rate is a fistulotomy (90-95%). However, if too much sphincter muscle is cut there is a risk of loss of control of ‘wind’ and rarely faecal leakage/incontinence and is not suitable for all fistulas. The other treatment options have a roughly 50% success rate although a plug is probably even lower than this. You should discuss the options with your colorectal surgeon.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Bowel Cancer (Colorectal cancer)

SEO Friendly Title: Bowel Cancer (Colorectal cancer)

What is bowel cancer?

Cancer occurs where normal cells in the body, through genetic changes, lose the ability to control and regulate growth. As cancers grow, they can invade tissue around them (local invasion). Through further genetic changes, cancers can also spread more widely, often first to local lymph nodes then to distant organs such as the liver or lungs. These are known as metastases or secondaries.
Bowel cancer is a growth of abnormal cells that line the bowel, generally the colon and rectum. Small bowel cancers are very rare. Untreated, bowel cancers continue to grow and can spread locally to adjacent organs such as the bladder and stomach, or distally to lymph nodes and then usually the liver.

How common is bowel cancer?

Bowel cancer is the second most common cancer in Australia. More than 16 000 new cases are diagnosed each year in Australia and 4 000 deaths. It is responsible for nearly 10% of all cancer related death.

What causes bowel cancer?

The underlying cause relates to cumulative genetic mutations in the cells lining the bowel. Bowel cancer is more common in developed countries and it is thought that the processed, low fibre foods we eat slow the transit of stool through the colon, exposing the cells to cancer producing substances for longer (carcinogens). There are a number of other risk factors for developing bowel cancer including:

What are the symptoms?

The most common symptoms are rectal bleeding and changes in the bowel habit. These are common symptoms that can be caused by a range of conditions but should always prompt a visit to the local doctor and referral for a colonoscopy to check for bowel cancer. Abdominal or rectal pain and weight loss are usually late signs. Iron deficiency anaemia should always alert the doctor to look for a gastrointestinal cancer usually colon. Many bowel cancers especially on the right side may not cause any symptoms until quite late.

How can I reduce my risk of bowel cancer?

There are a number of ways to reduce the risk of bowel cancer. These include:

What tests do I need?

If your doctor suspects that you have bowel cancer, a referral to a colorectal surgeon may be organised. Your local doctor or surgeon may perform the following tests:

How is bowel cancer treated?

Colorectal cancer requires surgery in almost every case to cure the disease. Some rectal cancers may benefit from radiotherapy and chemotherapy before surgery. If the cancer has spread to the liver or lungs, it is often not curable and chemotherapy is often used. If all of the cancer cannot be removed, this is called palliative chemotherapy. Sometimes, even if the cancer has spread to the liver or lungs, a cure is still possible with a combination of chemotherapy and surgery to the bowel cancer and sites of secondaries/metastases.

What are the prospects of cure?

When detected early, bowel cancer has a very high cure rate. The overall outcome will depend of the stage of the disease at presentation and you general health. Approximately 75% of all patients will be cured with surgery +/- chemotherapy.

What is the follow up after treatment?

Your surgeon will arrange a schedule of follow-up usually for 5 years after treatment of your cancer. This helps to identify problems that may arise and identify recurrent disease early. Follow up will include examination in the rooms and sometimes under anaesthetic, colonoscopy and imaging such as MRI, CT and sometimes PET scans.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Colonoscopy

SEO Friendly Title: Colonoscopy

What is a colonoscopy?

A colonoscopy is a procedure to look at the inside of the bowel using a specially designed flexible telescope. It is usually performed to diagnose or treat conditions affecting the bowel. Most colonoscopies are performed on an outpatient basis.

Who performs a colonoscopy?

Most colonoscopies in Australia are performed by Gastroenterologists or General Surgeons. A conjoint committee for the recognition of training in gastrointestinal endoscopy (CCRTGE) has been established compromising members from the Gastroenterological Society of Australia (GESA), the Royal Australian College of Physicians (RACP) and the Royal Australian College of Surgeons (RACS). Full recognition and credentialing typically occurs in the context of an advanced training program. An endoscopist with CCRTGE accreditation should perform your colonoscopy.

Who needs a colonoscopy?

A colonoscopy is recommended as part of the National Bowel Cancer Screening program (NBCSP) if you have a positive faecal occult blood test (FOBT). It is important to note that only 3% of patients with a positive FOBT will have a colorectal cancer. Other indications for colonoscopy include:

How is a colonoscopy performed?

The bowel is first thoroughly cleansed with “bowel preparation”. The quality of the colonoscopy is related to how well the bowel has been cleansed. Most of the time, sedation anaesthesia (“twilight”) is used during the procedure. The colonoscope is inserted through the anus into the rectum and then the colon. Often the last part of the small bowel (terminal ileum) will be examined. The endoscopist then carefully withdraws the colonoscope, removing polyps and taking biopsies as required. The entire procedure usually takes less than an hour. Following the procedure, slight discomfort may be present which is usually relieved after passing wind.

What is a polypectomy?

A polyp is an abnormal growth extending from the lining of the bowel. Around half of the population are likely to develop polyps. They do not usually cause symptoms but left untreated a small number will develop into bowel cancer. This usually takes many years. Removing the polyp prevents it from becoming a cancer and is an important way of protecting you from developing bowel cancer. Most polyps can be removed at the time of your initial colonoscopy. Sometimes, very large or complicated polyps may need a second procedure to be removed via either a colonoscopy (EMR – endoscopic mucosal resection) or sometimes surgically if the polyp is in the rectum (TAMIS – trans-anal minimally invasive surgery). Very large polyps have a risk of cancer in them and surgery is often recommended if cancer is detected.

What are the risks of a colonoscopy?

A colonoscopy is a very accurate and safe way to examine the lining of the bowel, remove polyps and take biopsies. There is a very small risk of missing a cancer (less than 1%). Bleeding from a biopsy or polypectomy site is uncommon and usually stops without any further intervention. Perforation of the colon (tear in the bowel) is a very rare complication that may require surgery to repair.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Constipation

SEO Friendly Title: Constipation

What is constipation?

Constipation is a very common medical complaint affecting most people at some time. Around 1 in 10 children will seek medical assistance and around 1 in 5 adults complain of being constipated. Most people regard constipation as when they cannot empty their bowels as easily or frequently as they would like to. For others, it is the passage of hard stools or difficulty with bowel motions. The range of “normal” varies from 3 bowel motions per day to 1 bowel motion every 3 days.

What causes constipation?

Constipation can be functional (no underlying cause) or may be due to an underlying cause (secondary constipation). Symptoms that may indicate a secondary cause include a recent change in bowel habits, rectal bleeding, weight loss, incomplete evacuation, needing to digitate to evacuate (use fingers) or abdominal pain.
Many of the causes relate to lifestyle. These include:

Other causes of constipation relate to medical problems and medications:

Underlying conditions leading to constipation include:

What are the common symptoms of constipation?

The most common complaint is infrequent bowel motions. Other symptoms include:

Does diet play a role?

A healthy diet with adequate fibre (or a supplement) and adequate fluid will be all that is required for many patients. Regular exercise and good toileting habits will also contribute. The best time to pass stools is usually early in the morning and after meals when the colon is stimulated with “mass movements”. Some people find lifting the knees above the level of the hips a useful technique to improve the angle for defecation. A small stool or foot-rest can assist.

When do I need to see a doctor?

Symptoms that should prompt a visit to the doctor include a change in bowel habits, abdominal pain/distension, rectal bleeding, weight loss, incomplete evacuation, a lump, needing to use fingers/digitation to evacuate. Also, persistent constipation requiring ongoing laxatives should prompt a visit to the doctor to make sure there is no secondary cause of the constipation.

How is constipation treated?

Most constipation is treated with the simple measures identified above as well as laxatives. There are different types of laxatives including:

Generally, a bulking agent is tried first although is not usually successful by itself for moderate to severe constipation and may worsen the constipation in some patients. A gentle stool softener such as a PEG preparation that is available over-the-counter is a good first line option and can be titrated for effect. Some patients require stimulants as well to improve their symptoms.

What might my surgeon do to treat constipation?

A surgeon is usually required if an underlying condition is discovered that is causing the constipation. The treatment will depend on the problem as follows:

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Crohn’s Disease

SEO Friendly Title: Crohn’s Disease

What is Crohn’s disease?

Crohn’s disease is a chronic inflammatory disease that can affect any of the gastrointestinal tract from the mouth to the anus. Most commonly however, it affects the last part of the small bowel (ileum). The colon and rectum are also commonly affected and some patients develop anal fistulas. It can also affect other parts of the body leading to skin rashes, inflammation of the joints and eyes. Some of these respond to medical treatment.

What are the symptoms of Crohn’s disease?

Symptoms vary from patient to patient depending on which part of the intestine is affected and the severity. Common symptoms include:

Who does it affect?

Any age group can be affected but most patients are young adults between 16 and 40. It affects men and women equally and around 1 in 5 will have a family member affected with Crohn’s disease.
Crohn’s disease is often grouped with a similar condition called ulcerative colitis (UC). Together they are know as inflammatory bowel disease (IBD).

What causes Crohn’s disease?

The exact cause of Crohn’s disease is not known. There is strong evidence that a combination of factors are probably involved including genetic, immunological, environmental and infectious (bacterial). It is likely that an interaction between these factors leads to IBD in a susceptible individual.

How is Crohn’s disease diagnosed?

Crohn’s disease can be difficult to diagnose as it can mimic a range of conditions including appendicitis, anal abscess/fistula and irritable bowel syndrome (IBS). Often a gastroenterologist or colorectal surgeon will make the diagnosis with a combination of imaging (CT scan, MRI small bowel), endoscopy (colonoscopy, pill cam), and pathology (biopsy or surgical specimen).

How is Crohn’s disease treated?

The treatment depends on the area of the gastrointestinal tract affected and the severity but is usually medical. Smoking cessation is critical. The medication options are similar to those used in UC. Medications like mesalazine seem to be less beneficial in Crohns, so generally immunomodulators such as azathioprine, 6-MP or sometimes methotrexate are used early in the disease course. When standard drug therapy is ineffective, newer biologics are now available such as infliximab and humira. These drugs are very expensive and are not subsidised on the MBS for all patients. Steroids such as prednisolone may be used in the acute phase to settle the inflammation but their side effects limit long term use.
Unlike with UC, Crohn’s disease cannot be cured by surgery because it is not possible to remove all of the bowel that can potentially be affected by Crohn’s.

What operations might I need and when?

Most patients (70-90%) will need surgery at some point. The type of surgery depends on the location and severity of disease. Emergency surgery is sometimes needed including for bowel perforation, bowel obstruction or significant bleeding. In general, the indications for surgery include:

The decision for surgery is best made in consultation with both your colorectal surgeon and gastroenterologist.

Who should do my surgery?

A colorectal surgeon who has appropriate training and skills in the surgical treatment of inflammatory bowel disease, and who works closely with your gastroenterologist. In Australia, members of the CSSANZ have this expertise.

Am I likely to need more than one operation?

Around half of patients will require a second operation after their initial surgery. This can be many years after the first operation. Your gastroenterologist will likely continue to treat you with medications to prevent disease recurrence.

Should surgery be avoided at all costs?

Whilst it is true that medical management is the mainstay of treatment in Crohn’s disease, surgery is required in around 4 in 5 patients at some point. Many patients suffer unnecessarily when they have a clear indication for surgery due to the mistaken belief that surgery will not help and will lead to complications. It is true that surgery is not “curative”, but it can provide sustained relief of symptoms and improve quality of life.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Diverticular Disease

SEO Friendly Title: Diverticular Disease

What is diverticular disease?

Diverticulosis is a common benign (non-cancerous) condition that affects around half of all Australians by age 60 and nearly all by age 80. Only a small percentage of patients will develop symptoms. Diverticulae consist of small pockets or out-pouchings of the bowel wall. They usually affect the left colon (sigmoid) but can affect any area of the colon (and rarely the small bowel). Diverticulosis describes the presence of these pockets.

What is the cause of diverticular disease?

Although not precisely known, it is believed that a low fibre diet is a major contributor to the disease. It is thought that the low fibre diet creates higher colon pressure particularly in the sigmoid colon and leads to the formation of diverticulae.

Can diverticular disease be prevented?

It appears difficult to prevent diverticular disease from forming in developed countries. A diet high in fibre or a fibre supplement is generally recommended to decrease the risk of complications.

What is diverticulitis?

Diverticulitis reflects inflammation of the bowel due to a microperforation of a diverticulae. This generally presents with lower abdominal pain and tenderness and a fever. A CT scan is usually required to make the diagnosis. Often, a mild attack can be treated at home but a severe attack may require admission to hospital.

What are the complications of divertilular disease and how is it treated?

The most common complication of diverticular disease is diverticulitis. This usually is treated with IV fluids and antibiotics. Other complications include:

Who needs surgery?

Surgery is generally only needed for patients with complications from diverticilitis. Recurrent episodes of diverticulitis significantly impacting on quality of life, complications from a severe attack such as perforation, stricture, fistulae or recurrent significant bleeding would all be considered indications for surgery. Often the diseased colon can be resected and joined to the rectum with complete recovery and low recurrence rates. In the emergency setting, a stoma is generally required.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Faecal Incontinence

SEO Friendly Title: Faecal Incontinence

What is incontinence?

Faecal incontinence is the impaired ability to control gas or stool. It ranges in severity from occasional problems with gas, to severe, with regular accidents and faecal soiling significantly impacting on independence and quality of life.
Normal continence relies on the ability to “sense” the contents of the rectum and hold on until an appropriate time to pass stool. This requires a healthy bowel and the coordinated control of the anal sphincter complex.

How common is it?

Incontinence is a common condition, especially in the older age group and in nursing home patients. It is estimated that 10% of Australians suffer with incontinence.

What are the causes of incontinence?

There are many causes including:

How is the cause determined?

A careful history will often provide a clue to the severity of symptoms, the type of incontinence and the potential cause. A rectal examination is usually required to assess tone and for sphincter defects. Further tests may be recommended and include:

What is the treatment?

Symptoms can be readily improved with simple treatments. Often this will involve dietary changes and some constipating medications and stool bulking agents especially if the stool is loose. Pelvic floor exercises and biofeedback with a physiotherapist can also significantly improve symptoms.
After adequately modifying stool consistency, some patients will still have troublesome incontinence. Your surgeon might recommend SNM.

What is SNM?

Sacral nerve neuromodulation (SNM) is a technique where a wire is placed using imaging guidance to the sacral nerves. The wire attaches to a battery which acts like a pacemaker, modulating nerve activity and significantly improving both urinary and faecal incontinence in most patients. Usually, a temporary wire is placed as a trial for 2 weeks to see if it will work for you. More information can be found on the Medtronic website.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Faecal Occult Blood

SEO Friendly Title: Faecal Occult Blood

What is the faecal occult blood test?

Faecal occult blood (FOB) refers to blood in the stool that is not visible to the naked eye. The test (FOBT) checks for this blood via a stool sample. The new test used as part of the National Bowel Cancer Screening Program (NBCSP) is an immunochemical test (iFOBT) that uses specific antibodies to detect globin.

Why should I do FOBT?

FOBT is a way to detect blood in the stool in the proportion of the population who do not have symptoms. This may be an indication of a significant polyp or even a cancer. Approximately 7% of patients tested will have a positive FOBT.

I have a positive FOBT. Do I have bowel cancer?

In Australia, only 1 in 33 patients with a positive FOBT will have a bowel cancer (3%). The rationale for screening is that it will detect the cancer when it is early before it has caused symptoms. There is also a rate of polyps of around 40% of patients with a positive FOBT. That means that 60% of patients with a positive FOBT will have a completely normal colonoscopy.

When should I do FOBT?

An FOBT is recommended for all Australians at average risk of bowel cancer from the age of 50 every 2 years. That is of course unless you have a strong family history, underlying genetic abnormality or other reason for colonoscopy such as symptoms like rectal bleeding or a history of inflammatory bowel disease.

What is the evidence?

Bowel cancer can be treated successfully in the early stages. It is estimated that screening with FOBT will decrease the risk of death by colorectal cancer by 15-25%.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Gallstone Disease

SEO Friendly Title: Gallstone Disease

What are gallstones?

Bile is made in the liver and stored and concentrated in a small pouch attached to the bile duct and liver called the gallbladder. The gallbladder is designed to contract and empty the bile into the intestines during a meal, especially a fatty meal to help with digestion. Gallstones are usually hardened deposits of cholesterol although can also be pigment stones.

What causes gallstones?

It is not clear exactly what causes gallstones although it is likely a combination of too much cholesterol in the bile to remain dissolved and the gallbladder not emptying correctly, leading to very concentrated bile in which precipitants can begin the process of stone formation. Stones range in size from a grain of sand to a golf ball.

What are the risk factors?

Gallstones are very common, affecting around 1 in 5 adults. Women have twice the risk of men. Many factors increase your risk of gallstones. These include:

What are the symptoms of gallstone disease?

Most people are not aware they have gallstones. The 3 most common problems associated with gallstones include:

  1.  Biliary Colic, which is a severe bout of pain where a gallstone blocks the gallbladder, preventing it from emptying its contents. It can be associated with nausea and vomiting and may last a few minutes to several hours. It usually follows a fatty meal and resolves when the stone is dislodged.
  2.  Cholecystitis refers to thickening and inflammation of the gallbladder wall when a stone gets completely stuck, prevents the gallbladder from emptying and does not resolve. It is often difficult to differentiate between biliary colic and cholecystitis as they are likely on a spectrum of the same disease process. Cholecystitis is likely if the pain has lasted longer than 4-6 hours.
  3.  Pancreatitis is often caused by gallstones. It is due to a small gallstone passing from the gallbladder into the common bile duct (CBD) and blocking the pancreatic duct.

There are a number of other less common problems with gallbladder disease including a severe infection in the bile ducts (cholangitis), gallbladder polyps and rarely gallbladder cancer.

What is the treatment of gallstones?

Surgery is generally indicated for patients with gallstones causing symptoms. Most often this is performed laparoscopically (key-hole) and known as laparoscopic cholecystectomy. This is often done during the same hospital admission for cholecystitis and pancreatitis. Patients with symptomatic or growing gallbladder polyps or large polyps (>8mm) should also have surgery. A dye test (intra-operative cholangiogram) is often performed at the same time to make sure the bile ducts are free of stones.


Patient Information: Haemorrhoids

SEO Friendly Title: Haemorrhoids

What are haemorrhoids?

Haemorrhoids are enlarged, bulging blood vessels covered by the lining of the anal canal. There are two types of haemorrhoids that describe their location relative to the anal canal.

What causes haemorrhoids?

Haemorrhoids are caused by weakening of the supportive connective tissue of the anal canal, leading to a bulge with a thin lining. Other factors include:

The tissues supporting the vessels stretch, the vessels dilate and the walls become thin and are prone to bleeding with minimal trauma.

What are the symptoms?

The most common symptom of haemorrhoids is painless bleeding. It is usually seen on the toilet paper or sometimes in the bowel especially at the end of the bowel motion.
Other symptoms include itch, lump and discomfort. Pain is unusual and unless there is a thrombosed external haemorrhoid is usually due to another condition such as an anal fissure.

How are haemorrhoids treated?

An important point to note is that the symptoms of haemorrhoids can be due to many other conditions including bowel cancer. You should consult your doctor with subsequent referral to a colorectal surgeon to ensure that the symptoms are properly evaluated and serious disease is excluded. This will often involve assessment with a colonoscopy.
Minor bleeding from internal haemorrhoids can often be managed with simple measures such as fibre supplement, adequate fluid intake and good toileting habits.
On-going bleeding with good bowel habits may require intervention.

The options for treatment include:

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Hernias

SEO Friendly Title: Hernias

What is a hernia?

A hernia is an abnormal protrusion of a cavity’s contents through a weakness in the wall of the cavity, taking with it the linings of the cavity. Abdominal hernias are the most common type of hernias. The most common types of abdominal hernias include:

What causes a hernia?

A hernia may be congenital (from birth) or acquired. In adults, hernias may arise due to pressure in the abdomen causing a weakness in the abdominal wall. These may be due to a range of factors including:

What are the symptoms of a hernia?

Most patients with a hernia will notice a lump. The lump may only be noticeable initially with straining or coughing. Over time, the size of the hernia can increase and the lump may always be present. Usually, gentle pressure over the hernia will enable it to “reduce” back into the abdomen. Sometimes, the hernia gets stuck and can’t be pushed back in. This will usually require more urgent treatment to fix the hernia.

Some patients complain of an ache, especially at the end of a day lifting or straining.

How are hernias treated?

The only effective treatment for a hernia is surgical repair.

There are different ways to fix hernias. These include laparoscopic, robotic or open repair. Almost all hernias require mesh to reduce the risk of recurrence. Your surgeon will discuss the options and recommendations specifically for you; this will depend on factors including your medical and surgical history as well as the type of hernia.


Patient Information: Irritable Bowel Syndrome (IBS)

SEO Friendly Title: Irritable Bowel Syndrome (IBS)

What is IBS?

IBS is a common condition that affects the colon or large bowel. People with IBS seem to have a very sensitive digestive system. It may affect as many as 1 in 10 people with women almost twice as likely to suffer from IBS. IBS is characterised by abdominal pain or discomfort that is related to passing flatus or faeces. There is usually an associated change in either the stool frequency or the consistency of the stool. Patients typically have diarrhoea, constipation or both at different times and some patients complain of abdominal bloating or fullness.

Symptoms that are not caused by IBS include bleeding, fever, weight loss, anaemia and night-time symptoms. These need further investigation to exclude other causes. Patients with new onset after 50, upper gastrointestinal symptoms (eg nausea/vomiting) and a significant family history also need further tests.

What causes IBS?

No one knows the exact cause of IBS. It is likely a complex interplay of many factors in a patient that is susceptible to developing IBS. These may include:

How is IBS diagnosed?

Many patients are concerned that their symptoms are related to a serious condition such as bowel cancer and seek medical advice. Your doctor may order some tests such as a blood test (Haemoglobin, CRP, celiac serology) and a stool (poo) test (faecal calproctectin) as initial screening to exclude some of the common conditions that may mimic IBS such as Inflammatory Bowel Disease (IBD) and celiac disease.

If your symptoms are typical and you are under 40 when you first developed symptoms, you may not need any further tests. Sometimes, a colonoscopy may be recommended.

How do you treat IBS?

Communication is very important. An explanation of the symptoms and diagnosis as well as treatment options can be reassuring.

There are a range of treatment options depending on your symptoms. These can include:

  1. Dietary modification – eg low FODMAP.
  2. Anti-diarrhoea medication – eg loperemide.
  3. Constipation treatment – eg fibre or laxatives.
  4. Pain medications – eg codeine which may also help with diarrhoea.
  5. Anti-spasmodic medications.

What is a low FODMAP diet?

= Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.

FODMAP’s are sugars (carbohydrates) that are poorly absorbed by the gut contained in many common foods such as wheat, garlic, onions, some fruit (eg apple/pear) and some dairy products.
As FODMAP’s are poorly absorbed by the small intestine, they reach the colon and are fermented by colonic bacteria. This leads to increased water secretion into the gut, increased “wind”/gas and an increase in short-chain fatty acids.

There is some evidence that a low-FODMAP diet can improve symptoms in patients with IBS. Once a low FODMAP diet has been established, some items such as dairy can be gradually re-introduced to test symptom response. Monash University have developed an app for patients on this topic.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Laparoscopic Surgery / Minimally Invasive Surgery (MIS)

SEO Friendly Title: Laparoscopic Surgery / Minimally Invasive Surgery (MIS)

What is Laparoscopic Surgery?

Laparoscopic surgery is surgery performed on the abdomen or pelvis through several small incisions 0.5-1cm in size. A camera attached to a long thin telescope (laparoscope) is used to allow the surgeon to visualise the inside of the abdominal cavity. Then utilising small instruments placed through the other incisions the surgeon can complete the operation. It is often referred to as Minimally Invasive Surgery (MIS) where the operation is performed with the least amount of surgical stress.

In abdominal surgery, MIS may refer to an operation being performed laparoscopically or robotically. Robotic surgery is a newer technique very similar to standard laparoscopic surgery but involving the surgeon manipulating a robot to move the surgical instruments.

MIS has been performed with increasing frequency and expanding indications over the last 20 years. Laparoscopic surgery was first used in gynaecology and then expanded to gallbladder surgery in 1985. Since this time, the amount of surgery performed as MIS has expanded to more complex and difficult procedures such as colon and rectum surgery. Many surgeons have now been trained to offer MIS to their patients.

What are the potential benefits of Minimally Invasive Surgery (MIS)?

As the incisions are much smaller than traditional surgery, patients typically have less pain following surgery. This can lead to a shorter time in hospital and faster recovery. There is also an earlier return to normal activities with less visible scarring. There may also be less long term problems compared with traditional open abdominal surgery such as adhesions (which can lead to obstruction) and hernias. Long-term outcomes are however similar between both techniques and the evidence supporting the benefit of MIS is in short-term outcomes.

Is Minimally Invasive Surgery (MIS) safe?

MIS has been extensively studied and is safe. The risks and complications are quite similar to traditional open surgery but the specific risk profile depends on the type of surgery and the condition being treated. It is important to discuss with your surgeon whether MIS is appropriate for you. Not all conditions and not all patients can be treated with MIS.

What colon and rectal operations can be performed using Minimally Invasive Surgery (MIS)?

Most operations performed for colon and rectal surgery can be performed using MIS. This includes cancer surgery, although the evidence is stronger for the benefits in colonic surgery.
Other factors may impair the ability of your surgery to be performed by MIS. These include the preference and experience of your surgeon, your surgical history and other characteristics such as the extent of the disease being treated (eg amount of inflammation or size of the cancer). These factors are all taken into account by your surgeon to individualise the best treatment for you.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Pilonidal Sinus

SEO Friendly Title: Pilonidal Sinus

What is pilonidal disease?

Pilonidal disease is an acute or chronic inflammatory condition in the midline of the natal cleft (tailbone). It is believed to result from a reaction to hair embedded in the skin in the crease between the buttocks. During World War II, nearly 100, 000 US army recruits were affected leading to the name “Jeep disease”. Pilonidal disease may present as an acute abscess or as a chronic pilonidal sinus.

What is the cause of pilonidal disease?

There are a few theories on the cause of the disease. The most popular theory is that it is an acquired disease due to loose hairs in the midline cleft. These are driven into the skin, leading to infection and/or chronic inflammation. There are a variety of other factors that influence the development of the disease. It is more common in men than women, more frequent in obese patients and those with thick course hair and deep natal clefts. It is unusual to develop pilonidal disease after the age of 40.

What are the symptoms?

Symptoms vary from no symptoms to a small lump to a large painful mass. There can be a chronic wound with discharge of fluid or blood. Sometimes, the sinus can become infected with a swollen, tender, painful red lump which may discharge pus with a foul odour. Some patients have recurrent infections or non-healing discharging wounds.

How is pilonidal disease treated?

Acute abscess – generally treated with incision and drainage under a general anaesthetic.

Chronic pilonidal disease – depends on the symptoms and the nature and severity of the disease. There is a wide spectrum in the severity of pilonidal sinus disease that dictates the treatment recommendations. There are a number of options including:

The best option for you depends on the disease and your symptoms and should be discussed with your surgeon.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Pruritis Ani

SEO Friendly Title: Pruritis Ani

What is pruritis ani?

Pruritis ani is Latin for “itchy anus”.

What causes Pruritis ani?

There are many different causes of pruritis ani. The skin around the anus is sensitive and difficult to keep clean. Moisture and small amounts of residual stool or mucous are the most common factors that cause this problem. Hair can aggravate the problem. A number of other common anal conditions such as haemorrhoids, fissures or fistulas can also lead to itch.

Other causes can include diabetes, inflammatory bowel disease or various skin conditions as well as allergies. In children, threadworm is a common cause. The skin becomes itchy. Scratching the skin temporally relieves the itch but can lead to skin damage and further irritation, thus setting up a persistent cycle.

Does poor anal hygiene cause pruritis ani?

While stool on the skin can cause itching, inadequate hygiene is not usually the major cause. Often, patients with a tendency for pruritis more vigorously and frequently wash the perianal skin. The soaps/lotions and minor damage from excessive cleaning can in itself be irritating and make the problem worse.

How is the cause of pruritis ani diagnosed?

Many patients are reluctant to seek help for fear of embarrassment. Pruritis is very common and a doctor can help with the diagnosis and management. The doctor will need to examine the anus to see if there is any pathology causing the problem.

What is the treatment for pruritis ani?

Surgery is not usually necessary unless an obvious cause such as a fissure is found. The most important thing to do is to keep the anal skin clean and dry without excessive cleaning. Treatment involves the following principles:

If strict adherence to these measures do not solve the problem, you may need to have your local doctor refer you to a skin specialist.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Rectal Prolapse

SEO Friendly Title: Rectal Prolapse

What is rectal prolapse?

Rectal prolapse is a condition where the rectum looses its normal attachments inside the body allowing it to protrude out through the anus. There are three main types of prolapse:

Why does rectal prolapse occur?

The precise cause in not known. There are a number of factors associated with prolapse including female, advancing age, chronic constipation with straining at stool as well as medical conditions such as connective tissue disorders. Possible explanations include a weak pelvic floor or inadequate fixation of the rectum. Prolapse affects women 6 times more commonly than men.

What are the symptoms of prolapse?

Commonly, patients first notice protrusion of the rectum through the anus initially during defecation. The prolapse may need to be pushed back by hand. Later, there can be discomfort, bleeding, mucous discharge and incontinence. The incontinence becomes more severe the longer the prolapse has been present.

Is prolapse the same as haemorrhoids?

Although some of the symptoms can be the same, haemorrhoids only involve the inner layer of the bowel near the anal opening.

How is rectal prolapse diagnosed?

A careful history and examination is usually all that is required to diagnose rectal prolapse. Sometimes it might be necessary to sit on the toilet to demonstrate the prolapse. Mucosal prolapse and internal prolapse may sometimes require further tests to diagnose accurately. These may include a defecating proctogram or an examination under a general anaesthetic. A colonoscopy may sometimes be required.

How is rectal prolapse treated?

Mucosal prolapse can be treated by rubber band ligation or sometimes by surgery. Incomplete prolapse is usually treated with bulking agents / laxatives but surgery is sometimes required.

Full thickness rectal prolapse usually needs surgery.

There are a variety of surgical options to treat prolapse. This includes both abdominal and trans-anal approaches. Most patients that are fit for surgery would be candidates for abdominal surgery.

This usually involves rectopexy and may be performed robotically. The trans-anal (perineal) procedures involve either stripping the mucosa (Delorme’s procedure) or a full thickness resection of the bowel (Altemeier’s procedure). After correcting the prolapse, patients with incontinence may be candidates for sacral nerve neuromodulation to improve their function (see Faecal Incontinence).

How successful is treatment?

The prolapse is generally well treated with either abdominal or trans-anal approaches. The abdominal approaches tend to be longer lasting with lower long-term recurrence rates. Bowel function can be considerably improved following surgery. For patients with prolapse that have had incontinence, it may take some time (up to 1 year) to regain optimum strength and function.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Robotic Surgery

SEO Friendly Title: Robotic Surgery

What is robotic surgery?

Robotic surgery in Australia involves using the DaVinci® robotic system. It is similar to laparoscopic surgery except that the surgeon does most of the operation controlling the surgical instruments via a surgical console. It is another example of Minimally Invasive Surgery (MIS). MIS has several proven advantages over open surgery including reduced postoperative pain, shorter hospital stay, improved cosmesis and faster return of bowel function.

Is robotic surgery safe?

Yes. Numerous studies have reported on the safety of robotic surgery. The short-term outcomes appear equivalent to laparoscopic surgery. There is emerging evidence that there may be reduced rates of conversion to open surgery especially in male and overweight patients.

What are the advantages of robotic surgery?

There are some inherent limitations with laparoscopic surgery. There is loss of a 3 dimensional view, use of long and sometimes awkward instruments that amplify physiologic tremor as well as assistant-dependent camera manipulation. This can make difficult MIS operations nearly impossible. Robotic surgery enables the surgeon a 3-D stereoscopic view with full range of motion similar to that at open surgery due to the articulated instruments. There is a stable camera platform controlled by the surgeon. This enables precision and control during the operation and may increase the number of operations that can be completed with MIS techniques.

Where is robotic surgery available?

Robotic surgery for colorectal surgery and hernia surgery is available at St John of God Hospital in Geelong.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Stomas

SEO Friendly Title: Stomas

What is a stoma (ostomy)?

A stoma is a surgically created opening between an internal organ and the body surface. Stomas are sometimes required during colorectal surgery, especially during an emergency operation or for surgery with a rectal cancer.

Stomas can be permanent or temporary. They can be “loop” (loop of bowel) or “end” (end of the bowel).

The most common type of stomas made include:

How will I control my bowel movement?

After a stoma is created, the stool will empty through the stoma and be collected by a specially designed pouch or bag. A stomal nurse will help you with learning how to manage this including support groups and where to access supplies.

Will my diet be limited?

Generally your diet will be the same as before. You may need to alter your fibre intake and take medications to control the volume and frequency of your bowel movements. Over time, most patients can have a normal diet without requiring any medications.

Will other people know I have a stoma?

Not unless you tell them. A stoma is easily hidden by your clothes.

Will it interfere with my physical activity or sex life?

Once you have recovered from surgery, you can resume normal activities. There are professional athletes competing with a stoma. Most patients with stomas will resume their normal sexual activity. There can be a change in body image that can be overcome with a strong relationship, communication and support groups.

What are the complications of a stoma?

While you are getting used to managing your stoma, occasional “accidents” can occur. Once you have adjusted to having a stoma, most problems are minor such as skin irritation that can be managed with simple measures such as pastes and powders. Other problems include hernias and prolapse. These may need to be fixed by a surgeon.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.


Patient Information: Ulcerative Colitis

SEO Friendly Title: Ulcerative Colitis

What is ulcerative colitis?

Ulcerative colitis is an inflammatory disorder that affects the lining of the large bowel (colon and rectum). The inflammation starts in the rectum and extends for a variable distance in a continuous fashion. It may involve just the rectum (proctitis) or the entire colon (pancolitis). It is uncommon and may present at any age often between 20-50. Occasionally, other organs can be involved including the liver (sclerosing cholangitis), eye (iritis) and skin (pyoderma gangrenosum).

Ulcerative colitis is pre-malignant and can lead to colorectal cancer. The risk of colorectal cancer relates to the severity, amount of colon involved and the duration of inflammation.

What are the symptoms of ulcerative colitis?

The main symptoms are of episodic or continuous diarrhoea with blood and mucous. There may be urgency to defecate, abdominal cramps/pain, weight loss and fevers. The symptoms can range from very mild to severe requiring hospital admission. The disease may have a continuous or a relapsing course and may even “burn-out” after many years.

What is the cause of ulcerative colitis?

The exact cause of ulcerative colitis is not known. There is strong evidence that a combination of factors are probably involved including genetic, immunological, environmental and infectious (bacterial). It is likely that an interaction between these factors leads to IBD in a susceptible individual.

How is ulcerative colitis treated?

Initial treatment of ulcerative colitis is medical management using medications such as salazopyrine or related drugs such as mesalazine. Sometimes anti-inflammatory drugs such as prednisolone or hydrocortisome are required to control the initial presentation or a “flare”. Medications may be given intravenously, orally or sometimes as local rectal preperations depending on the severity and disease location.

Immune suppressants such as azothiaprine and sometimes biologics such as TNF-∝ inhibitors may be required. Colonoscopy to assess the disease and screen for pre-cancerous change (dysplasia) is required.

When is surgery necessary?

Surgery is indicated when medical treatment can no longer control the inflammation or in the setting of pre-cancerous or cancerous change. It may also be required in patients who have a life-threatening complication of ulcerative colitis including massive bleeding, perforation or toxic megacolon.

What operation might I need?

The aim of surgery is to remove the entire colon and rectum. This may need to be done in more than 1 operation particularly in the emergency setting. There are then 2 options. The first is a permanent end ileostomy (see stoma). The second is to construct a “new-rectum” using small bowel (“pouch”). This results in a variable number of loose but controlled bowel motions.

Both of these options all but eliminate the risk of recurrent ulcerative colitis. Patients can develop inflammation in the pouch (pouchitis) which usually responds to antibiotics. In a small number of patients (<20%), the pouch fails to function and needs to be removed, leading to a permanent end ileostomy.

Who should do my surgery?

The decision to operate is always in consultation with both a surgeon and a gastroenterologist. Surgery for ulcerative colitis is challenging and should involve a surgeon who is trained in all aspects of colitis surgery including pouch surgery. In Australia, a colorectal surgeon who has undergone training through the CSSANZ training or alternative international pathway is most appropriate to manage your surgery.

What is a colorectal surgeon?

A colorectal surgeon is an expert in the surgical and non-surgical treatment of colon and rectal conditions. In Australia, a colorectal surgeon has completed general surgical training to be a specialist general surgeon (FRACS). A minimum of 2 years of clinical post-fellowship training is then undertaken in high volume accredited institutions through the Colorectal Surgical Society of Australia and New Zealand (CSSANZ). There is also a research requirement and a written examination on colon and rectal conditions. An equivalent domestic or international experience may qualify a surgeon for CSSANZ accreditation.