You have an appointment during the proctology consultation hour at HMC Bronovo. This consultation hour is for people who have symptoms of or around the anus, such as itching, pain, blood loss, swelling and warts. A surgeon conducts an examination and may perform minor procedures, such as treating haemorrhoids. A doctor’s assistant helps with this.
On this webpage, we explain the examination and how to prepare for it. There is also information about the treatment that may apply to you.
- No special preparation is required for this examination. You may eat and drink beforehand.
- Please bring the following with you to the hospital: your hospital card, referral letter (if applicable) and current medication overview (to be requested from your pharmacy).
- If you are using blood-thinning medicines, ask your referring doctor whether you should temporarily stop taking these medicines. Report this to the thrombosis service too.
- You must report to the Outpatient Clinic Surgery, route 23 in HMC Bronovo, 15 minutes before the agreed time.
- We advise you not to come by bike, scooter or motorbike and to have someone accompany you.
- We advise you to wear comfortable clothes and shoes.
Who will treat you?
You will be treated by the surgeon you saw at the outpatient clinic, a fellow surgeon or a physician assistant. A physician assistant is a graduate physician who we train at HMC to become a specialist or who is working at our hospital to gain experience. Physician assistants also perform (sections of) treatments independently. The medical specialist is always ultimately responsible for the treatment. By using different doctors, we can plan the treatments better and keep the waiting times as short as possible. If you
would prefer to be treated by the doctor you saw at the outpatient clinic, please let the doctor or the Admissions Office know.
- The doctor will first discuss your symptoms with you and ask you about your medical history and medication use.
- Physical examination: you take off your pants and shoes and lie down on the examination table. You lie on your left side, with your knees raised. The doctor looks at the anus and the area around it.
- Rectal examination: the doctor performs an internal examination with the finger. He/she uses anaesthetic ointment.
- Proctoscopy: you lie on your left side. The doctor introduces the proctoscope through the anus with the aid of anaesthetic ointment. The proctoscope is a tube about 10 cm long. It allows the doctor to view the inside of the rectum. Your doctor will discuss the findings with you and may treat haemorrhoids immediately. You may find that the examination is unpleasant and somewhat painful. If you try to relax, it will make a difference. This examination will take a few minutes.
- If necessary, haemorrhoids will be treated by means of the placing of rubber bands (see ‘Possible treatments’).
Outpatient treatment of haemorrhoids
Haemorrhoids are swollen veins in the anal canal. These are normally found just above the anus. These lumps seal the rectum in an airtight and watertight manner. If there is a lot of pressure, they can stretch, sag and even come out through the anus. This feels unpleasant and painful. Haemorrhoids can also bleed easily because of congested blood vessels.
During treatment, the sagging haemorrhoids are tied off with the help of small rubber bands. The haemorrhoid then dies in seven to ten days. You won’t always notice this. You may have some blood loss the first two weeks. This treatment will not hurt much. The treatment can be repeated several times if necessary.
Surgery for haemorrhoids
For large haemorrhoids, it is sometimes necessary to carry out a more extensive procedure in the operating room to remove them. This happens under anaesthesia or with an epidural.
Treatment of fissure
A fissure in the anus often causes symptoms in the form of (sharp) pain during or after bowel movements. This is often accompanied by blood loss. How the fissure develops is not clear. It might have something to do with a kind of cramp of a part of the sphincter and therefore an interrupted blood supply. A fissure usually responds to simple measures. Consider, for example, keeping the bowel movements soft (see ‘Lifestyle rules for smooth bowel movement’) and medication. In addition, your doctor may prescribe a non-transdermal vein-dilating and muscle-relaxing ointment, which you need to apply to the fissure several times a day. You must do this for at least three weeks before you’ll see any result.
If the fissure persists, your doctor may give a Botox injection. This reduces the increased tension of the sphincter which can heal the fissure. This Botox injection takes place in the (outpatient) operating room or during a new appointment in the proctology consultation hour.
Treatment of skin flaps, warts and fistula is carried out at a different time. This is done in the (outpatient) operating room under local anaesthetic.
After the examination and/or treatment
The doctor discusses with you what has been seen and/or done. If necessary, the doctor prescribes medication and gives (lifestyle) advice. You may be given a new appointment for follow-up treatment or monitoring.
After the outpatient treatment of haemorrhoids
- Immediately after the procedure, an urge to go to the toilet can arise. This is not a real urge but comes from the placing of the rubber bands. It is important to hold bowel movements for up to two hours after the treatment, otherwise, there is a chance that you will push out the bands. After two hours you can go to the toilet as usual.
- You may experience an unpleasant, heavy feeling two to three days after the procedure. You can take Paracetamol for this. A hot bath or shower also often helps relieve these symptoms.
- Some blood loss may occur after the procedure. This usually lasts a few days. If you have lost a lot of blood (more than a cupful), please contact the Outpatient Clinic Surgery (telephone number 088 - 979 43 59), or outside office hours the emergency room at HMC Westeinde on telephone number: 088 979 23 80.
- You can usually resume your daily activities after a day.
- It is important to keep bowel movements soft. You usually receive a prescription for this. It is also important to observe the following lifestyle rules in order to prevent you from getting haemorrhoids again.
Lifestyle rules for a smooth bowel movement
The following tips and advice to treat and prevent haemorrhoids are mainly aimed at preventing constipation and increased pressure on the anus:
Eat healthy, varied and high-fibre
Fibres ensure proper functioning of the intestines and absorb moisture in the stool. This keeps the stool soft and smooth. Fibres are mainly in vegetables, fruit and whole grain products. A healthy, varied diet contains all the nutrients you need every day. If in doubt, consult your doctor or dietitian.
Drink at least 1.5 to 2 litres of fluids every day. If you have a fibre-rich diet, it is wise to drink more. Fibres need moisture to work properly.
Get plenty of exercise
Regular exercise stimulates the bowel movement and can prevent constipation. By not sitting for long periods at a time, you prevent increased pressure on the anus.
Ensure healthy toilet behaviour
It is important to go straight to the toilet when you have an urge. Holding in the stool causes the stool to thicken. The chance of constipation increases as a result. If you have an urge, push gently. Do not strain hard when there is no urge. Good posture on the toilet is also important. Sit slightly bent over, with a footstool under your feet if necessary.
Ensure good hygiene
If you suffer from haemorrhoids, wash your anus after the bowel movement with lukewarm water. Then blot the anus dry. Use of soap or perfumed toilet paper can cause irritation and itching. A hot bath or shower can help relieve pain. Rinsing with cold water can help prevent itching.
If you have any questions, please contact the HMC Bronovo Outpatient Clinic Surgery by telephone on 088 - 979 43 59. We are available on workdays from 08:00 to 17:00.