1. Colorectal Disease: Conditions and Treatment Updates
Mr. R. Kalbassi, Consultant Colorectal Surgeon

2. Rectal Bleeding - Painless/ Painful Anorectal/ altered Conditions:
- Haemorrhoids
Fissure in ano
Diverticular Disease
Inflammatory Bowel Disease
Colorectal Cancer

3. Haemorrhoids Fresh Painless bleeding
- On toilet paper/ splashing into the toilet
- Internal / external
Pruritis ani
Treatment: Dietary advice, lifestyle changes, toilet training
laxatives, local creams and suppositories
- Left colonoscopy Vs full colonoscopy
Banding Vs injection of Haemorrhoids
- Surgery: Excision, HALO, Stapled haemorrhoidectomy

4. Haemorrhoids

5. Fissure in Ano - Break in an epithelium Painful fresh rectal bleeding
Anal spasm
“ Like passing glass” – sharp/stinging after Defaecation
Often after episode of constipation/ passing hard stool
Treatment: laxative, analgesia, dietary advice
Topical Rectogesic/ Diltiazem ointment for 6-8 weeks twice
Surgery: EUA + injection of Botox, EUA + lateral sphincterotomy

6. Fissure in Ano: Botulinum Toxin

7. Diverticular Disease/ bleed
Sacs/outpouchings In the wall of the bowel
Cause: high pressure in colon, diet low in fibre and high in red meat
” Diverticular bleed responsible for 17-40% of lower Gastrointestinal bleeds”
Painless bleed, fresh
Self-limiting
Common in elderly on anticoagulation
Treatment: Supportive, resuscitation, stopping anticoagulation,
Transfusion, Tranexamic acid
Left colonoscopy once stable/ CT angiogram/embolization
Surgery: resection

8. Inflammatory Bowel Disease
Fresh Rectal bleeding in colitis/proctitis
Associated with Crohns and Ulcerative colitis
Also in infective or ischemic colitis
Multiple fissures in ano in Crohns
Treatment: resuscitate, Tranexamic acid, Transfusion
Colonoscopy and biopsy
CT angiogram/embolization?
Treatment of underlying cause
Surgery: colonic resection

9. Colorectal Cancer 3rd most common cancer worldwide
Increase in incidence in under 50 years of age
Fresh rectal bleeding/ blood mixed with stool
About 4% patient with rectal bleeding diagnosed with colorectal cancer in patients of 34 years and over
Increasing age and association with other symptoms increase this risk to nearly 12%
Over 30% of rectal cancer with bleeding PR palpable on DRE
Treatment: Clinical assessment/ DRE, left colonoscopy/
Colonoscopy + biopsy, Radiological staging, MDT discussion,
Chemo/radiotherapy
Surgery: Robotic/ Laparoscopic/ open/ transanal (TEMS/TAMIS)

10. Rectal bleed - recommendations
Detailed history, examination, digital rectal examination
Low threshold for referral for left sided colonoscopy/colonoscopy
Treat fissure in ano with laxatives and local Topical ointment early
Caution as incidence of colorectal cancer increasing in young under 50
When in doubt refer or contact Colorectal surgeon for advice

12. Contact:
Mr. R. Kalbassi Tel: Fax: Address: Suite 4, Beacon Consultants Clinic, Beacon Court, Dublin 18