Dr Ehab Mansour is currently a consultant surgeon at St Bernard's Hospital and Ocean Medical Clinic, Gibraltar. He is a leading expert in laparoscopic and endoscopic treatment for the Colon and Rectum. He offers alternative non-operative solutions for haemorrhoids, pelvic floor disorders including poor control, severe anal pain and constipation.
Dr Ehab Mansour was an assistant professor of surgery at Royal College of Surgeons in Ireland RCSI, an Honorary Senior Lecturer in Surgery Limerick University and Trinity College of Dublin. He is currently a Fellow of the Royal College of Surgeons in Ireland, intercollegiate Royal College of Surgeons - UK. He is also a fellow of the European Association of Endoscopic of Endoscopic Surgeon EAES, Member of International Association of Laparoscopic Colorectal Surgeons.
Dr Mansour successfully had his Fellowship in Pelvic Floor and Coloproctology Dysfunction in Bristol University Hospital 2015 and earned his Master degree MSc in Laparoscopic Surgery 1996. His research focused predominantly on using key hole surgery for the treatment of Colon and Rectum Cancers.
“As a surgeon, I strive to give the best treatments using the most up to date technology and treatments, making sure I keep the upmost dignity and integrity for the patient”
What is coloproctology?
Coloproctology is a branch of medicine dealing with pathology of the colon, rectum, and anus and colorectal surgery.
Dr Mansour will offer services in fissure treatment with Botox, haemorrhoid non-surgical treatment, Haemorrhoidal Artery Ligation Operation (HALO), Irritable Bowel Syndrome (IBS), Proctoscopy, Colorectal cancer / polyp assessment, Assessment and arrangement of virtual colonoscopy (CT pneumocolon), Faecal incontinence, Pelvic floor assessment and Anorectal manometric studies.
Fissure treatment with Botox
Injections of botulinum toxin (Botox) may help heal a fissure (tear) in the anus.
The internal anal sphincter, which is one of two muscles that control the anus, is constantly under pressure. If this pressure is too high, spasms and reduced blood flow can lead to an anal fissure or prevent an existing one from healing. Botox temporarily paralyzes these tensed muscles reducing the spasm and allows the fissure to heal.
Haemorrhoid non-surgical treatment
What are haemorrhoids?
Haemorrhoids (piles) are the most common anal disease. Haemorrhoids are areas in the anal canal where tissue containing blood vessels have become stretched or swollen. This can occur due to increased pressure in the veins of the anus, because of childbirth, chronic constipation, obesity, diarrhoea, heavy lifting, family history or for no obvious reason at all.
What are the symptoms of haemorrhoids?
The symptoms of haemorrhoids include
- Anal itching
- One or more hard, tender lumps near your anus
- Anal ache or pain, especially when sitting
- Bleeding from your rectum
- A haemorrhoid that has fallen through your anal opening, called prolapse
Your doctor can often diagnose haemorrhoids based on your medical history and a physical exam. Dr Mansour diagnoses external haemorrhoids by checking the area around your anus. To diagnose internal haemorrhoids, Dr Mansour will perform a digital rectal exam and may perform procedures to look inside your anus and rectum.
Dr Mansour will ask you to provide your medical history and describe your symptoms. He or she will ask you about your eating habits, toilet habits, enema and laxative use, and current medical conditions.
Mr Mansour will check the area around your anus for:
- Lumps or swelling
- Internal haemorrhoids that have fallen through your anal opening, called prolapse
- External haemorrhoids with a blood clot in a vein
- Leakage of stool or mucus
- Skin irritation
- Skin tags––extra skin that is left behind when a blood clot in an external haemorrhoid dissolves
- Anal fissures—a small tear in the anus that may cause itching, pain, or bleeding
If required Dr Mansour will perform a digital rectal exam, to check the tone of the muscles in your anus, check for tenderness, blood, internal haemorrhoids and lumps or masses.
- Rubber band ligation. Rubber band ligation is a procedure that doctors use to treat bleeding or prolapsing internal haemorrhoids. This is a procedure in which elastic bands are applied onto an internal haemorrhoid to cut off its blood supply. Within five to seven days, the weakened haemorrhoid falls off and the wound usually heals within one to five days.
- Sclerotherapy. A doctor injects a solution into an internal haemorrhoid, which causes scar tissue to form. The scar tissue cuts off the blood supply, often shrinking the haemorrhoid.
Haemorrhoidal Artery Ligation Operation (HALO)
What does the procedure involve?
An enema is usually given an hour or so before the operation to clear the lower part of the bowel. The operation is usually performed under a general anaesthetic. During the operation the blood vessels feeding the haemorrhoids are identified using a special ultrasound probe. These vessels are then sutured to cut off the blood flow to the haemorrhoid.
Usually 3-4 vessels are found. The second part of the operation involves treating the prolapsing element of the haemorrhoid. Areas of haemorrhoidal prolapse are identified sutures are used to hold this up. This part of the operation is known as the Recto-Anal Repair (RAR).
What are the risks?
There are small risks associated with any operation. Bleeding can occur after any haemorrhoid surgery. Some patients will notice small quantities of blood, predominantly when they open their bowels.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a common, long-term condition of the digestive system. The signs and symptoms of IBS vary. The most common include:
- Abdominal pain and cramping that is typically relieved or partially relieved by passing a bowel movement
- Excess gas
- Diarrhoea or constipation — sometimes alternating bouts of diarrhoea and constipation
- Mucus in the stool
- Harder or looser stools than normal (pellets or flat ribbon stools)
The symptoms vary between individuals and affect some people more severely than others. They tend to come and go in periods lasting a few days to a few months at a time, often during times of stress or after eating certain foods.
Symptoms of IBS can be triggered by:
- Food. The role of food allergy or intolerance in IBS isn't fully understood. A true food allergy rarely causes IBS. But many people have worse IBS symptoms when they eat or drink certain foods or beverages, including wheat, dairy products, citrus fruits, beans, cabbage, milk and carbonated drinks.
- Stress. Most people with IBS experience worse or more frequent signs and symptoms during periods of increased stress. But while stress may aggravate symptoms, it doesn't cause them.
- Hormones. Women are twice as likely to have IBS, which might indicate that hormonal changes play a role. Many women find that signs and symptoms are worse during or around their menstrual periods.
How Is IBS Treated?
Nearly all patients with IBS can get help, but no single treatment works for everyone. You and Dr Mansour will need to work together to find the right treatment plan to manage your symptoms.
What is a proctoscopy (rigid sigmoidoscopy)?
A proctoscopy (also called rigid sigmoidoscopy) is a procedure to examine the inside of the rectum and the anus. It is usually done to look for tumours, polyps, inflammation, bleeding, or haemorrhoids.
Why is a proctoscopy done?
A proctoscopy is done to:
- Detect disease in the rectum or anus
- Find the source of anal bleeding
- Find the cause of diarrhoea or constipation
- Remove or monitor the development of existing polyps or growths
- Screen for colon cancer or monitor rectal cancer that has already been treated
What are the risks of a proctoscopy?
There is little risk associated with proctoscopy. It is possible that a patient may experience rectal bleeding as a result of the insertion of the proctoscope or if the lining of the rectum is irritated. A patient may also develop an infection after the procedure. Both complications are rare.
Colorectal Cancer / Polyp Assessment
Most colorectal cancers begin as a polyp (a growth in the tissue that lines the inner surface of the colon or rectum). Polyps may be flat or they may be raised. Polyps are common in people older than 50 years of age and most are not cancerous. However, a certain type of polyp known as an adenoma may have a higher risk of becoming a cancer.
What Happens If a Colorectal Polyp Is Found?
If colorectal polyps are found, they should be removed and sent to a laboratory for microscopic analysis. Once the microscopic type of polyp is determined, the follow-up interval for the next colonoscopy can be made.
Assessment and Arrangement of Virtual Colonoscopy
Why is this performed?
- To screen for colorectal cancer or polyps
- Monitor the growth of polyps
- Screen for recurrence of colorectal cancer in people who have had surgery for this disease
- Evaluate abnormal results from other colon tests
- Replace a regular colonoscopy if the thin lighted scope cannot be inserted in the colon for some reason, such as when a tumour blocks the passage
Faecal incontinence is the inability to control bowel movements, causing stool (faeces) to leak unexpectedly from the rectum.
Faecal incontinence may be accompanied by other bowel problems, such as:
- Gas and bloating
For many people, there is more than one cause of faecal incontinence. Causes can include:
- Muscle damage: This kind of damage can occur during childbirth, especially if you have an episiotomy or forceps are used during delivery
- Nerve damage
- Loss of storage capacity in the rectum
- Rectal prolapse
- Rectocele: In women, faecal incontinence can occur if the rectum protrudes through the vagina
- Dietary changes
- Exercise: If muscle damage is causing faecal incontinence, the doctor may recommend a program of exercise and other therapies to restore muscle strength
- Surgery: Treating faecal incontinence may require surgery to correct an underlying problem, such as rectal prolapse or sphincter damage caused by childbirth
Pelvic Floor Assessment
We offer a specialist pelvic floor assessment service and work in conjunction with a pelvic floor physiotherapist, who works closely with Dr Mansour.
We also have services designed to offer advice and treatment for people with the following problems:
- Bowel dysfunction, including biofeedback
- Faecal incontinence
- Irritable bowel syndrome
Anorectal Manometric Studies
What is anorectal manometry?
Anorectal manometry (ARM) is a diagnostic test that utilises a catheter and a balloon to study the nerves and muscles of the anus and rectum. It tests pressures and sensations in the anus and rectum. The catheter is small, like a rectal thermometer. It is attached to a computer that records the pressures.
How is the anorectal manometry performed?
A rectal examination is done before the test. A catheter with a balloon is passed through the anus to the rectum. The balloon is inflated, studying pressures and sensations. The patient may be asked to squeeze, cough and push the balloon out.
Are there any risks?
Anorectal Manometry is a safe, low risk procedure and is unlikely to cause any pain. Complications are rare. It is possible that a perforation (tearing) or bleeding of the rectum could occur.