Proctology

Problems affecting the anal canal and lower bowel are common, yet many people put off seeking help because they feel embarrassed. Symptoms such as bleeding, pain, swelling, itching or discharge can affect your comfort, your work and your confidence. In most cases these conditions can be treated effectively once the cause has been properly identified.

Professor Tan Arulampalam is a Consultant General, Laparoscopic and Colorectal Surgeon and has been a consultant at Colchester Hospital between 2003 and 2022. He now sees patients with proctological conditions in Colchester and central London, and aims to offer a calm, private and unhurried consultation in which you can discuss your symptoms openly.

What is proctology?

Proctology is the branch of medicine concerned with the anus, the anal canal and the rectum. It covers the diagnosis and treatment of conditions that cause symptoms in and around the back passage, ranging from minor problems that settle with simple measures to conditions that may need a procedure or an operation.

Many of these conditions share similar symptoms. Bleeding from the back passage, for example, may be caused by haemorrhoids or a fissure, but it can occasionally be a sign of a more serious bowel condition. A careful assessment by a colorectal specialist helps to establish the cause so that your treatment can be planned appropriately.

Conditions Treated

Professor Arulampalam has a particular interest in the minimally invasive treatment of the following conditions:

• Anal fistula: an abnormal tunnel between the inside of the anal canal and the skin around the anus, often following an anal abscess.
• Pilonidal sinus: an infected tract beneath the skin at the top of the buttock crease, near the tailbone.
• Haemorrhoids (piles): swollen blood vessels in and around the anal canal that may bleed, prolapse or cause discomfort.
• Anal fissure: a small tear in the lining of the anal canal that can cause sharp pain and bleeding when opening your bowels.

Your doctor can also assess other anal and rectal symptoms, including itching, lumps, discharge and changes in bowel habit, and can arrange further investigation where it is needed.

Minimally invasive and laser techniques

Where it is appropriate for you, your doctor will aim to use the least invasive approach that is likely to treat your condition effectively. For anal fistula, this may include video-assisted anal fistula treatment (VAAFT) and laser fistula closure. For pilonidal sinus, options may include endoscopic pilonidal sinus treatment (EPSIT) and laser ablation of the sinus tract.

These techniques are designed to reduce the size of wounds and limit damage to healthy tissue, which for some patients may mean less discomfort and a quicker return to normal activities. They are not suitable for everyone, and as with any procedure there is a possibility that the condition may recur or that further treatment may be needed. Your doctor will explain the options that are relevant to you, including their benefits, risks and alternatives, so that you can decide together on the approach that suits you.

Your consultation and examination

At your first appointment, your doctor will ask about your symptoms, your bowel habit, your general health and any previous treatment. With your consent, your doctor will usually carry out a gentle examination of the area. This may include a rectal examination and, in some cases, a sigmoidoscopy or proctoscopy, in which a short, narrow instrument is used to look inside the anal canal. A chaperone can be present, and you are welcome to ask questions or pause at any stage.

Depending on your assessment, your doctor may recommend further tests, such as an MRI scan, an examination under anaesthetic or an endoscopic examination of the bowel. Your doctor will then talk you through your diagnosis and treatment options in plain language.

Book an appointment

If you are troubled by anal or rectal symptoms, Professor Arulampalam sees patients for assessment in Colchester and central London, and you can book an appointment online or view the practice locations and contact details to arrange a consultation at the location that suits you best.

Please speak to your GP or seek urgent medical advice if you develop severe pain, a high temperature, heavy bleeding or feel generally unwell.