Perianal Conditions

This area of surgery relates to a number of conditions around the anus which can be embarrassing and may lead to patients not seeking medical advice and treatment. In many cases, failure to get treatment can lead to serious consequences. However, if seen and treated early, complications can be avoided.

Haemorrhoids (piles) are probably the most well-known problem, but there are also other lesser-known conditions which affect patients, including: perianal skin tags, perianal haematoma, anal fissure, fistula-in-ano, anal polyps and tumours.

What are Haemorrhoids?

We all have small haemorrhoids! These are the anal equivalent of lips around your mouth, being designed to prevent leakage outside the bowel. Haemorrhoids become a problem if they become excessively enlarged. This can lead to bleeding and in more severe cases, prolapse.

The exact cause of haemorrhoids is unknown; contributing factors include ageing, diet-related constipation/diarrhoea, faulty bowel function, prolonged straining, and pregnancy.

Haemorrhoids and their symptoms are one of the most common afflictions in the world. They can occur at any age and affect both men and women.

Although rarely fatal, they can be painful, embarrassing and disabling. Haemorrhoids are graded by degree of prolapse; the grading determines the most appropriate treatment method.

First degree – small swellings which develop on the inside of the anal canal.

Second degree – larger swellings which prolapse on going to the toilet but which return spontaneously.

Third degree – those which prolapse but can be returned inside manually.

Fourth degree – those which are larger and which cannot be pushed back inside. This results in marked pain and swelling of the haemorrhoid.


Haemorrhoids tend to get worse with time and are best treated as early as possible. Depending on the severity of the haemorrhoids, symptoms such as itching and discomfort may be alleviated by over-the-counter creams and ointments.

The majority of first degree, and some second degree, haemorrhoids can be treated in the surgical outpatient clinic without the need for general anaesthetic. In these cases, it is possible to apply a small rubber band onto the haemorrhoid to cut off its blood supply and thus shrink it back to its normal size (some surgeons prefer to inject the irritant phenol into the haemorrhoid to achieve the same effect). Only the most severe cases require surgery under general anaesthetic.

Large second degree and third degree haemorrhoids do require surgery. This can only be performed in cases where the condition has become chronic. Acute prolapsed/strangulated haemorrhoids should be allowed to settle down before surgery is attempted. A haemorrhoidectomy is the surgical removal of the haemorrhoid.

Conventional treatment methods include:

  • Cryotherapy
  • Infrared coagulation

Differential Diagnosis

Whilst haemorrhoids are the most common anal condition to cause these symptoms, your doctor should ensure that there is no other cause. Possible rarer causes for the above symptoms include:

Perianal Skin Tags

This is a condition which consists of small areas of loose skin protruding from the anal canal. Normally these are a result of a patient having had haemorrhoids which have “shrunk” leaving behind a small area of loose skin. These can be uncomfortable, irritating and lead to problems with personal hygiene. They can be removed very easily.

Perianal Haematoma

This condition is often misdiagnosed as a “thrombosed pile” but is actually an acute condition resulting from the rupture of a small blood vessel under the skin, adjacent to the anal canal. Typically the patient will give a history of sudden pain and the development of a painful lump whilst they were straining on the toilet.

Anal Fissure

This is a tear in the lining of the anal canal. It can be an acute or chronic condition and is often associated with a history of constipation. Usually the history relating to this problem consists of severe anal pain during defaecation. This can be associated with rectal bleeding, particularly after leaving the bathroom. The condition can lead to major problems if it becomes chronic, and can be difficult to treat.

Anal Polyps or Tumours

Polyps are fleshy growths which develop from the bowel lining. If these are near the anal canal they can prolapse outside the body and may mimic haemorrhoids. Some polyps may be premalignant and therefore need to be removed and tested.

It is also possible to develop tumours of the anus. This is a completely different disease to bowel cancer and can present in a number of different ways. If you have any concerns you should seek medical advice.


Sometimes a track (fistula) exists between the inside of the bowel and the skin around the anus; this is called a “fistula-in-ano”. This means that bowel content can be extruded down the track and lead to leakage onto the skin. Patients present with smelly discharge from a small hole somewhere around the anus. If the condition is left untreated, and the track becomes blocked, the bowel content can fester in the tissues around the anus and form an abscess, requiring urgent surgical drainage.

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Every patient is unique and deserves a compassionate, individualised care that allows them to gain back control of their lives. "

Denes Kovacs

Consultant General and Colorectal Surgeon

Areas of expertise

Special interest in functional gastrointestinal disorders - irritable bowel syndrome, dyspepsia, SIBO, chronic abdominal pain and their complex management. All areas of General Surgery - laser treatment of varicose veins, special expertise in open / laparoscopic hernia repairs, gallbladder surgery, skin lesions, ingrown toenails. Coloproctology - perianal conditions, haemorrhoids, fissures, fistulas and diseases of colon and rectum. Gastroenterology - Colonoscopy and gastroscopy.

Education and professional training

General Surgeon at Semmelweis University, Budapest. Pursued a Laparoscopic Colorectal Fellowship in the University Hospital North Tees, Durham, UK followed by the prestigious European Board of Surgical Qualification (EBSQ) examination in Coloproctology. He has recently completed his training for a second specialization in Gastroenterology at Semmelweis University, Budapest.

Professional Qualifications, Associations & Accomplishments

Specialist in General Surgery, Semmelweis University, Budapest - 2011 Fellow of the European Board of Surgeons (FEBS)- Coloproctology - 2021 Specialist in Gastroenterology, Semmelweis University, Budapest - 2024 (expected)

Professional experience

Having gained significant experience as a General Surgeon in Hungary, following a Colorectal Fellowship program in UK, held Consultant Surgeon position in NHS, Lincolnshire. Moved to Gibraltar in 2016 and have been since serving the local community in the GHA.

Languages spoken

English, Hungarian, Spanish, German, French, Romanian


Mountaineering, hiking, cycling, camping - getting lost in Mother Nature and sharing unforgettable adventures with my family.

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Mr. David Deardon BM MD FRCS FRCS(Ed)

Chief Executive / General Surgeon & Endoscopist

Areas of expertise

UK Trained Consultant General and Transplant Surgeon, now providing day case General Surgery and Surgical Gastroenterology to SMC

Education and professional training

Trained at Southampton Medical School (BM) 1984. Became a Fellow of both the Royal College of Surgeons of England (FRCS) and the Royal College of Surgeons of Edinburgh (FRCS Ed) in 1989. Completed EU Surgical Training in 1990 and UK Surgical Training in 1996. Completed my Doctorate at Manchester University in 1999

Professional Qualifications, Associations & Accomplishments

Over 20 published scientific papers in peer reviewed journals Presented and co-authored a number of scientific presentations at international congresses in Japan, Europe, India, USA and the UK. Accredited as a specialist in General Surgery in 1997 and joined the GMC’s specialist register.

Professional experience

Held consultant posts in Plymouth (Senior Lecturer /Associate Professor), Guys and St Thomas’s Hospitals London, Oxford Radcliffe (Honorary Tutor to Green College and involved in the initial development of the highly successful Oxford Pancreas and Non-heart beating kidney transplant programmes), the Western Infirmary, Glasgow (reintroduced the

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Doing exciting things with my family, travelling (to explore cultures and geography); philately, jigsaws and skiing.

Competency, empathy and compassion for my patients"

Mr. Fady Narouz MBBCh, IFRCS

Consultant Colorectal and General Surgery

Areas of expertise

Colon and rectal cancer, perianal disease (haemorrhoids, fistulas, fissures), colonic and rectal polyps, advanced colonoscopy and gastroscopy, open and laparoscopic hernia surgery, gallbladder surgery, minor skin lumps and bumps, ingrowing toe nails, emergency general surgery.

Education and professional training

MBBCh Cairo University, 2004. Completed training in 2017 in the Republic of Ireland, Dublin University Hospitals. Colorectal Fellowship at St. James's University Hospital, Leeds. Trauma Fellowship at King's College Hospital, London

Professional Qualifications, Associations & Accomplishments

FRCS, Fellowship of the Royal College of Surgeons, Ireland - 2016 Member of the ACGBI (The Association of Coloproctology of Great Britain and Ireland)since 2017. GMC and Gibraltar Medical Board registered.

Professional experience

Irish and UK trained Colorectal and general surgery consultant with 17 years working in the surgical field. I am the Colorectal Cancer lead at the GHA. Experienced in laparoscopic bowel cancer resections, hernias, cholecystectomies and advanced endoscopy with over 3000 procedures.

Languages spoken

English, Arabic


Squash, SCUBA diving instructor, chess, volleyball. I also have an interest in Diving and Hyperbaric Medicine with a post graduate degree from the University of Aberdeen.