My apologies if this has already been discussed here, but if I missed it, then other people probably did too. I just came across this article and wondered if anyone had any experience with this or any opinions. Surely someone here has had a haemorrhoidectomy; what did that do to your IBS symptoms?-----------------------------GP CLINICAL: IBS breakthrough points the way to potential cure. GP. Jan 20, 2003 p63.Full Text: COPYRIGHT 2003 Haymarket Business Publications Ltd. Dr John Lockley explains how he became involved in research that offers hope of a cure for irritable bowel syndrome It is axiomatic that if there are many different treatments for a disease, we do not understand its cause. This is certainly the case with irritable bowel syndrome (IBS), current treatments for which range from antispasmodics to hypnotherapy. All this may be about to change as the result of studies pioneered by Mr Bernard Palmer, consultant surgeon at the Lister Hospital in Stevenage, Hertfordshire. These studies have led to a paper based on a long-term audit of patients presenting with piles and fissures, who also had IBS symptoms (Int J Colorectal Dis 2002; 17: 402-11). This showed that surgical correction of prolapsing rectal mucosa and other anal abnormalities abolishes or significantly alleviates IBS symptoms in 86 per cent of cases - which is far higher than for any other treatment for IBS. What is more, he has discovered a useful sign for IBS. When performing a digital rectal examination, applying pressure specifically to the low posterior anal canal would produce unexpected discomfort, to a degree that the patient would often grunt or cry out - which led to this informally being named the 'Oooh sign'. Chance observation The research began 10 years ago with a chance observation. A patient on whom Mr Palmer had recently performed a standard haemorrhoidectomy mentioned in passing that her IBS symptoms had been relieved at the same time. He began questioning other patients with IBS symptoms and discovered a similar pattern of improvement. He then set up a formal study, with which I became involved. All patients referred with benign anorectal symptoms were asked to complete detailed questionnaires about symptoms. IBS sufferers were identified using the standard Rome criteria (including symptoms such as bloating, abdominal tenderness and a feeling of incomplete evacuation). On examination, the incidence of haemorrhoids, prolapsing mucosa, posterior rectal tenderness and papillae was noted. The prolapsing mucosa can often only be seen when the patient strains with a proctoscope in place. The abnormalities were corrected using a banding haemorrhoidectomy. The effects were compared with similar operations on patients who had anal symptoms but not IBS. Results obtained using late follow-up questionnaires were striking. Of the 144 patients with symptoms of IBS, 72 per cent had marked relief after the operation, with a further 14 per cent achieving partial relief. Symptoms often disappeared completely. In cases where the symptoms returned after a time, this was usually associated with a recurrence of prolapsing rectal mucosa or other anal problems. 'Tidying up' the rectum again (which usually meant applying further Baron's bands), would again achieve a reduction of IBS symptoms. Our paper postulates a possible mechanism that in IBS the rectal area is more sensitive. In turn, this produces reflex nervous impulses that cause the intestine at a higher level to contract excessively, increasing the pressure in the gut and causing further changes in bowel habit. This diarrhoea or constipation causes the rectal mucosa to prolapse, which irritates the rectum even more. Thus a vicious circle is set up: irritation of the rectal area stimulates the higher gut, which causes changes in bowel habit, which in turn further promotes rectal changes. This vicious circle is difficult to break, which explains why IBS can be a long-standing illness. However, if surgical intervention can correct the rectal abnormalities, it appears that the cycle can be broken. We suggest that psychological and nutritional changes may markedly affect the ano-enteric reflex, amplifying it to varying degrees. This would explain why psychological treatment can often help IBS, without being able to abolish it. Latest conclusions What are the implications of our findings? Firstly, we may now have a sign for IBS - posterior anal tenderness, which was present in 79 per cent of IBS cases seen in outpatients. In addition, piles, the presence of high tone in the anal sphincter, or prolapsing mucosa on straining proctoscopy are useful extra pointers to the possibility that IBS is the diagnosis. A diagnosis of 'stress' or 'nerves' should not exclude patients from active treatment of these abnormalities. The results seem striking, but research so far has been confined to one surgical unit and needs to be repeated in other centres. A randomised trial is being set up. If the paper's findings are confirmed, then medical science will have an understanding of the mechanism of IBS, and a definitive cure in most cases. KEY POINTS - Nearly 80 per cent of IBS patients have the signs of posterior anal tenderness. - More than 80 per cent of IBS patients with anal symptoms experienced improvement or even cure after treatment of the anal problem.