‘All staff in GP surgeries are bound by confidentiality’
Q
FOR the past few weeks I’ve had terrible pain when I pass a motion. I eventually saw my doctor, who said I had an anal fissure and prescribed cream, but it seems to give me a headache. Can you explain why the fissure occurred and is there any other treatment?
AA SMALL tear in the lining of the entrance to the back passage, known as an anal fissure, can cause pain when you pass a motion which can be severe and last for several hours.They are usually caused by passing a large, hard stool, especially if you strain to go, so are more likely to occur if you suffer from constipation.
They can occur at any age (including infants) but are more likely in those of middle age. Small fissures often heal within a few weeks, as long as you take steps to keep your stools really soft, which means eating plenty of fibre and drinking lots of water. However, with slightly larger fissures the muscles around the anus can go into spasm and this in turn can reduce the blood supply to the area, which can delay healing.
For this reason the most common prescribed treatment is a cream containing glyceryl trinitrate, which widens the blood vessels and can aid healing.
Unfortunately, though it is applied to the anal area, it can cause widening of blood vessels elsewhere in the body and this leads to headaches. If this happens, stop treatment for a couple of days and then restart with once a day, working up gradually to twice a day.
If the cream does not work, or your headaches persist, then an injection of botox can relax the muscles of the anus, but you will need a referral to a specialist for this. If you find it difficult to keep your stools soft with diet, then stools softeners such as lactulose can be helpful and are safe to use long term.They are available from chemists and on prescription.
QI’VE noticed that a couple of moles on my skin seem to have grown a bit in the last year. I contacted my GP via the new messaging service and she asked me to send in photographs.
I thought the NHS was back to normal now so why can’t I go into the surgery? Who else is going to see the photos? Is the system secure?
AGPs have had to completely change the way they treat their patients in response to the pandemic. Though the rate of infection has fallen, the virus is still circulating, and so surgeries have to take steps to keep both their patients and staff as safe as possible.This means dealing with patients remotely – not having them coming into the surgery, as much as is safely possible.
It’s also proved to be a lot quicker and more efficient, as we can deal with far more patients in a day by using email and the phone, than seeing every patient in person.
NHS email addresses (which end in @nhs.net) are very secure and though it is possible your photos may be dealt with by a receptionist, who will load them onto your individual medical records, all staff are bound