SYMPTOMS
At the heart of all the treatments offered is a patient-centred approach. Ensuring you are fully informed of all options and have a detailed understanding of the treatment offered is of utmost importance. Mr Chand believes in a collaborative approach with his patients whereby all decisions are made together.
All procedures are carried out using the latest modern equipment in line with national guidance. Mr Chand is appropriately accredited for all treatments offered and does not consult for any procedures outside his expertise and practise.
RECTAL BLEEDING
Bleeding from the back passage can be caused by a number of conditions. Whilst most cases are self-limiting and usually due to less serious conditions such as haemorrhoids or an anal fissure, it can represent something more serious. It is commonly investigated using a telescopic camera into the bowel called a colonoscopy or flexible sigmoidoscopy.
There are now improved stool sample tests which can better risk stratify rectal bleeding to whether there is underlying disease. These are available from your GP or through The London Clinic. These include FIT (faecal immunochemical test) and FCP (faecal calprotectin). Please see here
CHANGE IN BOWEL HABIT
Most people are aware of a pattern to their bowel habit. A change may result in diarrhoea or constipation. This can be due to a new diet or medication or even a mild gasteroenteritis. However, sometimes this may represent a more chronic condition and this needs further investigation commonly with a colonoscopy. Specific stool tests may be useful such as faecal calprotectin or a faecal immunochemical test which may risk-stratify the condition better.
COLORECTAL CANCER
Colorectal cancer is one of the most common cancers with approximately 40,000 new cases per year in the UK. Symptoms may include bleeding form the bottom or blood in your stool, a change in bowel habit and weight loss. It is important to consult your doctor early and have an appropriate investigation such as colonoscopy. When caught early, most cases are treatable with an operation.
Mr Chand is one of the UK's highest volume colorectal cancer surgeons undertaking some of the highest numbers of colorectal cancer surgeries in London. These are almost exclusively performed as minimally-invasive procedures. He is also a globally recognised authority on colorectal cancer. All cases are discussed in the London Clinic MDT alongside a specialist team of radiologists, oncologists pathologists and specialist nurses. If you have been offered 'open surgery' for your procedure, please enquire about minimally-invasive surgery options as there is almost always an alternative to more historic approaches. A laparoscopic (or robotic) surgery is recommended for patients with colorectal cancer to improve recovery, reduce short- and long-term complications, and even result in more accurate oncological outcomes.
You may read Mr Chand’s latest publication in Nature journal on the management of rectal cancer here and more information at Cancer Research UK here.
ANAL FISSURE
A fissure is a small tear in the lining between the skin and the anus. It is commonly caused by a hard stool during constipation. You may experience severe sharp pain on going to the toilet along with bright red blood in your stool.
Often the appropriate cream may resolve the problem along with a change in diet and toileting advice, but in some cases an injection of Botox or a surgical procedure such as a lateral internal sphincterotomy may be required.
HAEMORRHOIDS
Haemorroids, also known as piles, occur when the lining of the anal canal becomes engorged with blood. This is commonly associated with straining on the toilet and constipation however they can occur spontaneously. They can cause bleeding most frequently but also other symptoms such as discomfort, itchiness and lumps in the bottom. It is important to exclude other more sinister causes when embarking on treatment for haemorrhoids.
There are a number of options available to treat haemorrhoids ranging from outpatient procedures through HALO/THD and excisional haemorrhoidectomy. Mr Chand will provide you with a tailored treatment plan.
You may read Mr Chand’s review on hemorrhoids and rectal bleeding here.
INFLAMMATORY BOWEL DISEASE
Inflammatory Bowel Disease (IBD) includes Crohn's Disease and Ulcerative Colitis. Symptoms commonly include diarrhoea, abdominal discomfort and pain, weight loss, and mucus discharge. Mr Chand favours a multidisciplinary approach for these conditions and works with a fantastic team of radiologists, nutritionists and gastroenterologists to offer bespoke treatment plans.
You can read Mr Chand's published review on IBd here
FISTULA
Anal fistula can develop after having an abscess in the bottom. It can lead to annoying and persistent discharge as a communication is established between the skin near the anus and the rectum. This may present as bloody or pus in the underwear. Often these can be treated with a simple operation such as a lay open but in some cases a series of procedures are needed using a variety of techniques. Mr Chand offers a spectrum of treatments tailored by the best MRI equipment and team of expert radiologists.
BLOATING
Bloating can be a real problem for many people. Excessive wind, discomfort, increasing abdominal size may all be attributed to bloating. In the vast majority of cases, bloating is not associated with underlying physical pathology or a sinister condition. It is usually described as a ‘functional bowel disorder’ and there may be an association with diet and environment. The key to managing these symptoms is to exclude any underlying disorder and then develop a strategy personalised to the individual. We work with gastroenterologists and nutritionist who can help create a personalized approach.
