I get asked this question a lot by patients in my clinic. Mostly the problem with your tail end starts with a bout of constipation. This can hit any of us at any time and commonly occurs at times of pregnancy, stress or travel. Hard motions and straining can then lead to lumps swelling on the tail end.

We know these are painful! They can become acutely thrombosed (aubergine effect!) which leads to INTOLERABLE pain and maybe even an A+E attendance. They can bleed and swell. For the lucky ones, the symptoms subside and hopefully all returns to normal. In some patients however, the angry painful swollen anus settles down to frilly bits of loose skin, dangling from the anal verge. So far so good??

You may go to see your doctor or look online about what to do. The loose skin can be unhygienic and mucus/stool escapes through the folds of skin throughout the day. Skid marks! This can be upsetting but not a harmful condition. The frilly bits get longer because of wiping. Swapping to a bidet can really help here. Occasionally the tissue may catch during exercise/manual labour. Overall this can be bothersome.

And yet surgery to tidy up this area is generally thought of as cosmetic in the field of colorectal surgery. Some may go as far as to say it is not recommended to have these removed as the pain from the wounds may outweigh the benefits, particularly if cosmetic outcome is the goal.

I believe that the real underlying issue lies with body confidence and embarrassment during your intimate life. There are many things that we are self conscious about and the ability to relax and enjoy an intimate life is profoundly important. It is perhaps very difficult to discuss in an outpatient appointment with a surgeon. It may be that you don’t feel it is worth mentioning as it may influence whether or not we offer you an operation to remove the area.

The majority of surgery offered to deal with haemorrhoids is aimed at treating symptoms – rectal bleeding, itchy mucus leakage and lumps that protrude. We have a raft of options available including rubber bands, injections, laser destruction and stitches to stem the blood supply. Mostly these techniques are not aiming to treat the external appearance of your anus. By signing up to these types of treatments it is worth being honest about symptoms so that you are fully aware of what to expect after surgery and what your anus will look like. Many patients will wake up from surgery with their anus looking exactly the same as when they went in for surgery. This can be disappointing…

At The McCarthy Clinic we have treated over 500 patients with haemorrhoids. We have found that the cosmetic appearance can be really important for patients, just as important as worrying symptoms such as bleeding. Restoring the appearance of your anus back to the flat state that it once was is very rewarding work! We take great care to inform you about the surgery, the aftermath and what to expect in the longer term. We have found that restoring anatomy in this delicate area can be life changing for some.

thanks to Ben Lyric for the cosmetic photo