At Sydney Colorectal Clinic, our areas of expertise.
Proctology conditions are common but often less spoken about conditions that many people experience. Dr Urquhart has a sub speciality interest in proctology conditions and treatment.
Dr Hamish Urquhart specialises in treatment of haemorrhoids. Firstly it is worth mentioning that haemorrhoids are very common. Haemorrhoids are vascular cushions within the anal canal. With symptomatic haemorrhoids, patients may experience itchiness, pain, bleeding or prolapse. Haemorrhoid treatments often starts with increasing fibre in the diet to avoid constipation, drinking more water though the day to avoid dehydration or hard stools, avoiding straining excessively on the toilet and limiting toilet time. Dr Urquhart can also discuss different topical ointments to help with non surgical treatment of haemorrhoids. Sometimes surgery is required, but it is worth noting that surgery can offer great results. Modern techniques in haemorrhoid surgery aim at treating the underlying condition in a more comfortable way than they have been historically.
Injection of haemorrhoids: This is utilised for earlier/less severe haemorrhoids and involves either injecting oily phenol or almond oil into the haemorrhoids.
Banding of haemorrhoids: This is utilised from slightly larger haemorrhoids and involves placing small bands internally above the haemorrhoids to help shrink the haemorrhoids and limit blood flow to the haemorrhoids to help prevent bleeding.
Haemorrhoid Artery Ligation: For larger haemorrhoids, under general anaesthetic, Dr Urquhart utilises an ultrasound or other device to find the haemorrhoid vessel causing the issue and he subsequently places a dissolving stitch internally to prevent bleeding. During this procedure Dr Urquhart can also repair some of the prolapse associated with some larger haemorrhoids.
Haemorrhoidectomy: Occasionally haemorrhoids can be so sizable they require an operation where the require surgically excision under General Anaesthetic.
Anal skin tags are excess section of skin near the anal canal that can be troubling. They are quite common and can cause issues with discomfort or difficulty toileting. They can develop as part of the aging process, through associated haemorrhoids, following pregnancy or can develop by themselves without any specific prior issue. This condition can be fixed through a simple day surgery procedure. Dr Urquhart can discuss the different treatment options during your consultation.
Fissures are painful breaks in the skin or lining of the anal canal that can be incredibly uncomfortable. Most patients experience pain on passing a bowel motion which can persist through the day. The pain is due to spasm of the anal sphincter complex and can be quite debilitating
Treatment involves avoiding constipation and protecting the skin near the anal canal by using wet wipes and applying emollients or protective creams.
Some topical ointments can help. Rectogesic is a brand of ointment which helps by relaxing the sphincter spasm. Diltiazem is another ointment which can be prescribed as an alternative which is often better tolerated but is made specially through a compounding pharmacy. Dr Urquhart can discuss all these options with you.
In cases in which there is a persistent or troublesome fissure, an injection of botox can help. This is a fairly quick day surgery procedure completed under a light general anaesthetic. During the procedure an injection of botox is administered to relax the sphincter spasm relieving the pain and also allowing the underlying fissure to heal. There are other surgical options also available for complex fissures which can be discussed during your consultation.
Perianal fistulas often commence as an infected oil gland in the anal canal which ruptures at the skin resulting in a connection (or tunnel) between the anal canal and the skin. A fistula can result in discharge, pain or recurrent infections. Dr Urquhart has been specially trained in complex and recurrent fistulae. The treatment is highly specialised and will depend on severally factors. Occasionally fistula surgery requires a series of procedures to best treat the condition.
Seton drain: this is a rubber band often placed in the first instance when the fistula is diagnosed. A seton drain helps to control the infection that can occur when people have fistulas. They work by preventing infection build up in a fistula. Usually they are placed in the first instance as a bridge to definitive surgery.
Excision: if possible a fistula may be surgically excised.
Reconstruction/Sealing/closing the fistula tract: if the fistula tract cannot be excised, the tract may be sealed up or closed using different techniques. Options include clips, plugs or advancement flaps that help to seal up the tract through different methods. Dr Urquhart can explain these options in depth during your consultation. Each operation is tailored towards your specific case.
Dr Urquhart is a member of the International Anal Neoplasia Society and works in the High Resolution Anoscopy clinic based at the St Vincent’s Hospital Sydney. High resolution anoscopy is performed by only a small number of centres in Australia and is utilised to assess patients where there is a concern that anal lesions or precursors to cancer may develop. During high resolution anoscopy, a microscope is utilised to inspect for any abnormal cells. Dr Urquhart can then co-ordinate any further treatment you may require. Dr Urquhart can discuss the different investigations and treatment options during your treatment.
Pilonidal disease refers to a condition of the skin and hair where a chronic irritation or infection may develop near the buttocks and coccyx. Usually the area of irritation is due to an abnormal pocket of skin that contains hair and skin debris. Dr Urquhart provides speciality treatment of this condition which usually is based on a combination of skin care and surgery including the reconstructive surgical options.
Dr Urquhart has a special interest in diverticular disease. Dr Urquhart takes a holistic approach to assessing and treating this sometimes challenging condition. Dr Urquhart specialises in recurrent and complex cases of diverticulitis.
Firstly it is worth noting that diverticular disease of the large bowel is incredibly common. Approximately 60% of the population at the age of 60 have the condition known as diverticulosis. Diverticulosis refers to outpouchings or pockets of the large bowel, which occur at a weak anatomical point on the muscular covering of the colon. This allows the inner lining to bulge out. The bowel may have many small or large-sized diverticulums. A diverticulum can become infected or inflamed (which is when we use the term diverticulitis). 20% of patients with diverticulum will develop diverticulitis at some stage.
The treatment of diverticulitis is constantly changing. Occasionally in mild episodes, the inflammation settles by itself over a few days. Patients should keep their fluids up, take simple analgesia and rest up. If patients can have anti-inflammatories, these often help (so long as they are only taken for a short period). Antibiotics are typically used in worse cases of diverticulitis.
Some cases of diverticulitis require hospital admission. In these circumstances, Dr Urquhart will monitor inflammatory markers with blood tests and often arrange imaging of the abdomen through a CT scan or MRI. The treatment of active diverticulitis cases often requires intravenous antibiotics, an IV drip to keep your fluids levels up, and bowel rest.
Following an episode, you may need to initially be on a low-fibre diet (low roughage) to limit the material passing through the colon. Longer term, once an episode has fully settled, avoiding constipation and maintaining a high-fibre diet is beneficial. Dr Urquhart can help with nutritional advice and referral to a dietician.
In cases where the inflammation is severe or recurrent, sometimes surgery is needed. Dr Urquhart specialises in surgery for Diverticulitis.
If a patient experiences recurrent diverticulitis, constantly requires antibiotics updates for flare-ups or doesn’t fully recover from an episode of diverticulitis, surgery can often help. In this, often through a keyhole-assisted technique, surgically resecting or removing the chronically inflamed segment of the intestine can help significantly. Dr Urquhart can discuss all the different investigations and treatment options in depth during your consultation. It is quite a complex condition, and Dr Urquhart will thoroughly explain the options for treatment.
- Colonoscopy and upper endoscopy are procedures during which a flexible camera inspects the gastrointestinal inner lining. These procedures are usually performed under a light sedation anaesthetic and are typically completed as day procedure cases.
- In an upper endoscopy, the flexible camera inspects the oesophagus, stomach and upper small intestine. Depending on the indication of the procedure, biopsies may be taken to analyse for digestion abnormalities, stomach lining infections, and other causes of reflux or peptic ulcer disease. Dr Urquhart can go through the different details and treatment strategies before your procedure.
- In a colonoscopy, a flexible camera inspects the anal canal, rectum, large bowel and lower end of the small intestine. This may be required to investigate for a change in bowel habit, for cancer or polyp surveillance, or to follow up investigation of the government's faecal occult blood test (FOBT). Colonoscopy may also be required to investigate for inflammatory bowel disease, diverticular disease or other colonic or rectal problems. Dr Urquhart performs these procedures through the St Vincent’s Campus (St Vincent’s Private, St Vincent’s public and St Vincent’s Private Day Surgery)
- In some cases, Dr Urquhart can book you directly for your procedure via a telehealth review prior. If you would like to be contacted for a direct booking for a gastroscopy or colonoscopy, please contact us.
Rectal Prolapse refers to a condition where the rectum protrudes out through the anal canal. The condition is highly variable, ranging from mucosa (or superficial) prolapse to full-thickness rectal prolapse. The condition can develop through the aging process, but certain weaknesses of the pelvic floor or anal sphincter complex can predispose to the condition. Complex childbirth deliveries may also increase risk. Patients of any age and any sex can develop the condition.
- Symptoms can range from anal discharge or seepage to full-thickness prolapse, where patients feel their rectum protrudes to the point where they need to press the rectum back into place manually. Some patients may not feel the prolapse protruding but experience issues with the sensation of incomplete emptying of the rectum.
- Dr Urquhart will arrange all the investigations to assess the area and discuss available treatments. Dr Urquhart will help coordinate the surgical and non-surgical treatment options for you. If undergoing Surgery, this can be minimally invasive, and there are multiple different procedures.
- Broadly speaking, the procedures for rectal prolapse aim to repair the prolapsing bowel, excess rectum or weak pelvic floor. In a Delorme’s procedure, the protruding mucosa (superficial lining of the bowel) is resected, and the intestine is repaired using dissolving sutures. In Altemeier’s procedure, the prolapsing bowel (both the superficial and deeper layers) is excised, and the intestine is repaired using dissolving sutures. Delorme’s and Altemeier’s procedures can be completed under a lighter type of general anaesthetic to avoid the need for major abdominal surgery.
- If the rectal prolapse is quite significant, with a sizable portion of the rectum protruding out, sometimes an abdominal procedure is required. This is completed via laparoscopy (or ‘keyhole” surgery), where the strength of the pelvic floor and rectum is supported to prevent prolapse.
- Dr Urquhart will discuss all the different treatment options and strategies that can best treat your specific problem
Faecal incontinence is a troubling condition. Many patients have put up with symptoms for quite some time before seeking help. Often patients have had symptoms for years and have been suffering before realising treatment options are available. The condition can range from anal seepage to incontinence of gas or stool. This can occur due to weaknesses of the pelvic floor and or anal sphincter complex. Dr Urquhart has a subspeciality interest in Faecal Incontinence Surgery. There are multiple treatment strategies for Faecal Incontinence which range from dietary changes, medication management, pelvic floor physiotherapy and surgery. Dr Urquhart employs a compassionate and caring approach to incontinence treatment and will spend time going through all the available options.
In the first instance, it is worth filling out our incontinence questionnaire to help determine the extent of your symptoms. This is a three-week questionnaire that Dr Urquhart will ask you to complete daily to help record the aspects of your continence control.
To view the questionnaire, click here.
Following this, Dr Urquhart will review your case and arrange preliminary investigations (pelvic floor imaging, functional studies and colonoscopy). Depending on the findings, Dr Urquhart can arrange pelvic floor physiotherapy and other biofeedback programs to help with the condition.
In some cases, surgery is required. The surgical option depends upon the outcome of our investigations and is tailored to each patient.
Surgery may include;
- Sphincter injection
- Sphincter repair
- Sacral nerve stimulation
- Prolapse surgery
These surgeries can be life-changing in the treatment of incontinence. Dr Urquhart will discuss in depth the options available for you.
Dr Urquhart is a member of the International Anal Neoplasia Society and works in the High-Resolution Anoscopy clinic based at St Vincent’s Hospital Sydney. High resolution anoscopy is performed by only a small number of centres in Australia and is utilised to assess patients where there is a concern that anal cancer may develop. During high-resolution anoscopy, a microscope is utilised to inspect for abnormal cells that can be signs of a cancer precursor.
If a precursor for cancer is detected (Low-Grade Squamous Intraepithelial lesion (LSIL) or High-Grade Intraepithelial lesion (HSIL)), then further treatment or close surveillance may be required, which we complete through our clinic.
In cases of anal cancer being detected, Dr Urquhart specialises in treating anal cancer and can coordinate your treatment with the group of specialists involved in the care of this condition. In confirmed anal cancer, treatment typically involves a combination of chemotherapy and radiotherapy with rates of cure that continue to improve. In most cases, chemoradiotherapy provides a cure for the condition. Surgery may also be required to either confirm the diagnosis, provide initial treatment or, in cases where further treatment after chemoradiotherapy is required. All anal cancer cases are discussed at our Cancer MDT through St Vincent’s Hospital.
Colorectal cancer is incredibly common, occurring in as many as 1 in 11 Australians and is the second most common cancer in Australia. Colon polyps can be a precursor to colorectal cancer, where growths of the bowel lining develop. It is a condition that has a good prognosis and a good chance of a cure, especially when detected early. Colorectal Cancer is treated principally with surgery however may require additional therapies with either chemotherapy or radiation therapy. Colorectal cancer treatment is constantly progressing and improving.
The cause of colorectal cancer is multifactorial. Colorectal cancer typically develops from polyps in the bowel where environmental and inherited factors are implicated. Diets high in red meat, obesity, smoking, lack of physical exercise, and excessive alcohol intake have all been shown to increase the risk of colorectal cancer. In contrast, diets high in fibre, vegetables and fruit have been shown to decrease the risk of cancer developing. However, some patients develop polyps or colon cancer without risk factors, where abnormalities of the colon lining develop on their own.
Polyps commence as outpouchings of the lining of the bowel. Given time, they may develop into bowel cancer. However, it is generally accepted that their rate of transition to cancer occurs over an extended period of time. Because they can turn into cancer, removing polyps is critical in cancer prevention. Removal is usually performed during a colonoscopy; however, occasionally, surgery may be required (see Surveillance & Complex Colonoscopy section above).
Bowel cancer may be present in patients with no symptoms; hence, screening is incredibly important. When symptoms are present, they may include a change in bowel habits (diarrhoea, constipation or bleeding). Anaemia (a low blood count) is another relatively common presentation. Pain and weight loss are usually late symptoms, as is a bowel obstruction or blockage.
Colorectal cancer is generally treated with surgery tailored to your specific case. Dr Urquhart will help manage your case with a team of cancer specialists.
Depending on your case, the best option for your surgical treatment may include laparoscopic (keyhole surgery), endoscopy, open surgery or robotic surgery. Dr Urquhart will discuss all the different options with you and ensure your treatment is completely evidenced based. Dr Urquhart operates through the St Vincent’s Health Campus (St Vincent’s Private, St Vincent’s Public and St Vincent’s Day Surgery) and consults through his speciality rooms in Paddington.
Surgery for colorectal cancer
Dr Urquhart is a specialist in minimally invasive keyhole surgery for colorectal cancer and has completed 5 years in General Surgery training followed by 4 subspeciality training years in advanced laparoscopic, robotic and endoscopic surgery. Dr Urquhart is also the chair of the St Vincent’s Hospital Enhanced Recovery After Colorectal Surgery Working Group.
Colorectal cancer surgery refers to surgery of the colon or rectum aiming to remove cancer and any potential lymph glands that tumours may spread to. Depending on the site of the tumour, a section of the intestine on either side of the tumour will be resected. The surgery aims to resect the tumour and any potential microscopic tumour cells. Following this, in most cases, the intestine is then joined back together with a combination of staples and dissolving sutures.
The resected specimen is then sent to our pathology team for analysis. From this, the characteristics of the tumour, possible spread to lymph nodes and need for additional treatment is determined.
All of our colorectal cancer cases are discussed in a multidisciplinary meeting at the Kinghorn Cancer Centre.
In this meeting, your case is discussed with our group of colorectal surgeons, radiologists, oncologists, radiation oncologists, genetic counsellors and allied health teams.
Dr Urquhart specialises in the treatment of Inflammatory Bowel Disease (IBD). The two most common types of Inflammatory Bowel Disease are Ulcerative Colitis and Crohn’s Disease. Symptoms can be quite variable between patients and require a specialist team approach. Dr Urquhart is a member of the St Vincent’s Inflammatory Bowel Disease MDT and will help coordinate your care with gastroenterologists, dieticians, wound care nurses and allied health teams. Dr Urquhart specialises in keyhole and laparoscopic surgery for inflammatory bowel disease.
When affecting the intestine, inflammatory bowel disease may cause symptoms of abdominal bloating, weight loss, intermittent fever, diarrhoea, colonic mucous production or rectal bleeding.
Ulcerative colitis is a condition that affects the large bowel (rectum and colon), and the inflammation within the intestine starts from the rectum working its way backwards through the colon.
Crohn’s Disease can affect any of the components of the intestine. The inflammation from Crohn’s disease may extend anywhere from the mouth, oesophagus, stomach, small bowel, large bowel and anus. Patients with Crohn’s Disease may also experience fistulas near the anal canal.
Both conditions (Ulcerative Colitis and Crohn’s Disease) may also affect other body parts, including the eyes, skin, joints and liver. The conditions have been extensively researched, and there is ongoing debate and investigation into the underlying cause.
The diagnosis of inflammatory bowel disease is often made during colonoscopy or endoscopy, where biopsies of the intestine are taken and analysed. Blood tests, stool tests and imaging investigations (MRI or CT scans) may help assess the extent of the illness. Fortunately, most patients can be treated successfully with modern medications that help to treat the condition by either leading to complete remission or major symptomatic control.
Surgery is sometimes required for different reasons. Occasionally, infections develop (for example, Crohn’s disease and perianal abscesses or fistula) and are best treated with surgery. Occasionally the illness either doesn’t respond to medications or patients are unable to take the medications. In these circumstances, surgery may be suggested as the next step of treatment. Dr Urquhart is a specialist surgeon in the condition and will explain all the different surgical options. In cases where medication therapy or nutritional assistance is needed, Dr Urquhart will coordinate your care with the Inflammatory Bowel Disease MDT.
Useful website: www.crohnsandcolitis.com.au
Dr Urquhart specialises in laparoscopic hernia surgery, surgery for recurrent hernias and surgery for complex abdominal wall hernias.
- A hernia is a bulging or protrusion of an organ or tissue through an abnormal opening. The more common abdominal hernias are groin hernias (which can be over the inguinal or femoral region) or abdominal wall hernias (ventral, umbilical/belly button, supraumbilical/above the belly button). Hernias can also develop after surgery if a weak point develops over the incision site.
- Multiple factors contribute to the development of a hernia. There are genetic, environmental and patient-specific factors that all contribute to a hernia developing. Straining, chronic cough, smoking, constipation, heavy lifting, and many other activities may predispose to hernias forming. Once a hernia develops, most of the time, surgery is required.
- Abdominal wall defects or hernias may develop spontaneously or following any abdominal procedures. These may be quite small or extensive, where the patient has a large defect in which abdominal contents bulge out. In small to moderate-size hernias, the repair may require a suture technique or, more commonly, a combination of a suture with either a graft or mesh may be required. Occasionally additional treatments such as preoperative botox, weight loss strategies and exercise plans may be required.
- Dr Urquhart is a specialist in hernia repair surgery and can discuss all the options with you.
Dr Hamish Urquhart is also a trauma surgeon at St Vincent’s Hospital, a major trauma tertiary hospital in Australia and a world leader in the area. St Vincent’s hospital is a major trauma referral centre accepting admissions from throughout the state. As a trauma surgeon, Dr Urquhart is involved in complex emergency trauma operations and admissions. Dr Urquhart employs a multidisciplinary approach with our other surgical colleagues, including Cardiothoracic Surgery, Neurosurgery, Orthopaedic Surgery, Liver/UGI Surgery, Interventional Radiology and Intensive Care. In addition, Dr Urquhart will coordinate your care with our allied health team of physiotherapists, occupational therapists and rehabilitation specialists.