At Home with Chris Jessen 2018 - 74
MEET THE EXPERT
Bright red blood after a bowel movement should never be
ignored. A specialist can provide a diagnosis and reassurance
ectal bleeding is a common
condition affecting more than
50% of the adult population. It
can be broadly categorised into
painless or painful bleeding, with pain
arising in the perianal region.
Severe pain following or during
defaecation, associated with rectal
bleeding, is often a sign of anal fissure.
Painless rectal bleeding can be a
symptom of a number of conditions,
including haemorrhoids. Other benign
causes of rectal bleeding include
diverticular disease and angiodysplasia.
Bleeding that occurs with diarrhoea
can be associated with inflammatory
bowel disease, for example ulcerative
colitis or Crohn's disease.
Irrespective of age, rectal bleeding
requires investigation. Although the
incidence of sinister pathology below
the age of 45 is low, the symptoms
should not be ignored.
The investigation of choice is
colonoscopy, which involves the
insertion of a lubricated tube into the
back passage under intravenous
sedation. This procedure is very well
tolerated by patients when undertaken
by an expert. An alternative to
colonoscopy is an imaging procedure
called CT pneumocolon, which tends to
be reserved for older or infirm patients.
The most common cause of rectal
bleeding is haemorrhoids. More than
50% of the adult population have them
IS VERY WELL
and once confirmed using colonoscopy,
management involves techniques
such as haemorrhoidal banding or
Both procedures are painless and can
be undertaken as a day-case procedure
simultaneously with colonoscopy or
without sedation in an outpatient clinic.
A small or large benign polyp identified
during colonoscopy can be removed
MSc, MS, FRCS,
is a founding
consultant in the
units at The
Hospital and the
Hospital of St John
and St Elizabeth
in London. Both are recognised as
international centres of excellence.
Mr Navaratnam trained in Nottingham,
Cambridge, London and Sri Lanka before
being appointed consultant laparoscopic
colorectal surgeon at the North
Middlesex University Hospital and
honorary senior lecturer at the Royal
Free Medical School. His specialist
interests include the investigation and
management of common and complex
gastrointestinal problems, including
altered bowel habit, irritable bowel
syndrome (IBS), rectal bleeding,
haemorrhoids, fissures and fistulae.
Other major interests include
endoscopy and colonoscopy.
Laparoscopic (keyhole, or minimally
invasive) surgery is used to investigate
conditions of the gall bladder and groin,
abdominal herniae and appendicitis.
A large number of laparoscopic
resections are undertaken for benign
conditions, such as diverticular disease;
inflammatory bowel disease, for example
Crohn's disease and ulcerative colitis;
and colorectal cancer.
Mr Navaratnam is the cancer lead at
his NHS hospital. His work over the past
15 years has been associated with very
positive outcomes and he has recently
been approached by an international
organisation that promotes specialists
within the top 10% of their field.
through therapeutic colonoscopy,
usually at the same sitting.
The identification of bowel cancer may
require laparoscopic (keyhole) surgery.
Outcomes following laparoscopic surgery
are excellent, with the vast majority of
people returning to their normal
activities within four to six weeks.
For rectal bleeding, colonoscopy,
which is a straightforward and well
tolerated procedure, can provide
strong and instant reassurance.
FOR MORE INFORMATION
Call 020 7078 3832
Hospital of St John & St Elizabeth
and The Wellington Hospital
(Platinum Medical Centre)