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SPLIT-ENDS, BOTOX AND BLEACHING.
BEAUTY SALON OR COLOPROCTOLOGY CLINIC??
BY PROFESSOR CONOR MAGEE MD FRCS, CONSULTANT SURGEON
Over the last thirty years surgery has evolved into what
we call sub-specialty practice. Traditionally a General
Surgeon operated on all parts of the body. In the 1940s
it was not unusual for the same surgeon to be able to
operate on a broken limb, remove your stomach and treat
your prostate (or womb!)
painful. The textbook description of the pain is like a knife
up the bottom.
However, as operative techniques and perioperative care
improved it became clear that the best results were seen
by those specifically trained in one area. Today we have
urological surgeons (kidneys, bladders and prostates),
orthopaedic surgeons (bones and joints) and many more
specialties. Unlike cuts or tears anywhere else in the body, fissure-
in–ano is notorious for poor healing. The reason is the
bottoms response to pain is to clam up tight - this reduces
the blood supply to the tear. The lack of blood supply and
oxygen (ischaemia) delays healing. And of course the pain
and tightness will make constipation worse - which means
the passing of a motion is harder… and a vicious cycle is
established. This combined with the embarrassment that
patients have of discussing bottom problems means misery
for many.
I was trained as a General Surgeon and my specialist area
is upper gastrointestinal surgery - but the commonest
specialist area is colorectal surgery. Colorectal surgeons
deal with the colon and rectum (obviously) but they also
are experts in proctology - diseases of the bottom. For years the standard treatment was to divide the tight
muscle away from the tear (lateral sphincterotomy) in a
small operation to allow healing to take place. Although
this is sometimes required, today colorectal surgeons have
leveraged the weapon of the beauty therapist - Botox.
Admittedly, it may not be as sexy as say Transplant Surgery-
but bottom complaints are amongst the most common
and debilitating diseases. In fact, one of the most famous
hospitals in the world - St. Mark’s in London was founded
by Frederick Salmon in 1835 as “The Infirmary for the
Relief of the Poor afflicted with fistula and other diseases
of the rectum”. He did this to treat conditions he considered
'the most distressing that can afflict our common nature”.
Charles Dickens was an early sufferer and benefactor to the
hospital! Botox is a miracle of modern science - it is actually the
deadly neurotoxin that causes the disease Botulism. Botox
blocks the neuromuscular junction preventing muscles from
contracting. The same muscles that cause wrinkles cause the
tight sphincter. Injecting Botox relaxes the sphincter. It is
quick, simple and very effective in curing fissure-in-ano and
has transformed its management!
One of the most excruciating bottom conditions is a
Fissure-in–Ano. This is literally a split end! The lining of
the anal canal is torn, normally by the difficult passage
of a constipated, hard stool. The tear exposes exquisitely
sensitive nerve fibres and makes passing a motion incredibly But Professor Magee, you haven’t talked about bleaching?
Believe me you don’t want to know….
Remember, if you have any bottom complaints - please see
you doctor. Don’t suffer alone - we can help.
Professor Conor Magee is Consultant Surgeon at Spire.
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