Phone: 905-575-5743

726 Upper James Street

Hamilton, Ontario L9C 2Z9




A colonoscopy is a procedure that uses a flexible telescope (colonoscope) or a tube to look inside your large intestine or the colon in order to diagnose diseases like polyps (growths) and cancer of the large intestine. The colonoscope is also crucial for trying to determine why you may have a change in bowel habits, bleeding or abdominal pain. The colonoscope, which has a camera at the end of it, will be inserted into your rectum and moved along the entire length of the colon. Through a small valve on the colonoscope, air will be injected into the intestine allowing the doctor to see on a television in front of them the inside of the colon.

By performing the colonoscopy the doctor will be able to see if there are any abnormalities inside the colon including any abnormal growths such as polyps and or cancers. If abnormal growths are detected the doctor will try to remove the growths or alternatively take a sample of the growth (biopsy). All the tissue samples taken at the time of the colonoscopy will be sent to a laboratory that will carefully assess the specimen to determine if the specimen is benign or cancerous.


Prior to having a colonoscopy, you may need to have a SEPARATE appointment at which you meet with a specialist who will go over your medical history and the indication for a colonoscopy. If your medical history is simple and you are deemed to be at low risk, you may be referred to us by your Family Physician to go directly to your procedure. Based on your health and the information we receive from your Family Physician, you may not need to attend a consultation on SEPARATE day.

If you are given a SEPARATE appointment for a consultation, you will meet with a specialist who will go over your medical history and the indication for a colonoscopy. A physical exam will be carried out followed by a discussion regarding the colonoscopy. It is IMPORTANT to have the consultation to ensure that the right procedure is being done to address your concerns and that it is safe for you to undergo the procedure. Once the procedure and its potential complications have been discussed and you agreed to have the procedure you will be asked to sign a CONSENT agreeing to have the colonoscopy done. Following you will be given a prescription and a clear set of instructions regarding the preparation of your bowel that is required for you to take before the colonoscopy can be performed. Prior to leaving the clinic you will be given a date and time for your procedure along with contact information for the GHA clinic such that if any questions arise you can call the clinic to have your questions addressed.

IF you are not able to attend the colonoscopy, it is YOUR RESPONSIBILITY TO CALL GHA SURGICAL CENTRE at 905-575-5743. GHA expects a 3 working day notice for any cancellation and/or change of date. This will allow the GHA sufficient time to schedule another patient in your slot. If you do not show up to your appointment and you have not informed the clinic you will charged $150


Please see our Preparation Instructions under our “Patients” tab at the home screen.


On the day of the colonoscopy you will be brought to the assessment area where a nurse will insert an intravenous that will allow the anesthetist to give you medication for the colonoscopy. You will then be transferred to the colonoscopy suite where you will have both monitors and oxygen placed on you. Once in the room you will be introduced to the physicians who will be giving you the medication and performing the colonoscopy. Sometimes the medication can cause stinging at the injection site. Possibilities of other side effects/complications from the medication include an allergic reaction, blood pressure fluctuations, and rare heart or lung complications. These serious complications are extremely rare. The anesthetist will be available to discuss any further questions.

You will be asked to lie comfortably on your left side or on you back. Afterwards the anesthetist will give you medication known as sedatives to make you relax. The sedation will tend to make you sleepy and forgetful. The procedures will then start and should last approximately 20 minutes. Most people say that the preparation for the colonoscopy is the hardest part of having the colonoscopy. Majority of patients sleep through the procedure while others remain awake and watch the procedure on the TV.

Once the procedure is done you will be taken to the recovery room by a nurse who will continue to monitor you until the medications have worn off and you are awake and alert. Once you are ready to go home you will be given clear instruction on how to care for yourself after the colonoscopy along with note stating the appropriate follow up for your procedure. You MUST ALWAYS have another adult with you to take you home after the procedure..

You cannot drive a motor vehicle or operate machinery or engage in other tasks that require attention or concentration for 24 hours after having sedation.


The complication from the colonoscopy are infrequent. The bowel preparation can lead to rare abnormalities in your electrolytes. It is therefore important that you tell you physician during your initial consultation if you suffer from any diseases that affect your kidneys or electrolytes. Similarly if you suffer from any heart disease and or any respiratory symptoms it is important that you relay that to your physician at the time of your consultation.

The colonoscopy itself carries a small risk of both bleeding and or perforation (making a hole in the bowel) . The risk of bowel perforation is about 1 in 3,000 for a diagnostic procedure, but if polyps need to be removed, the risk increases to 1 in 1,000. If a perforation occurs, surgery is usually needed. The risk of bleeding is also rare and occurs in approximately 1/2000 colonoscopies where polyps are removed. If bleeding occurs, it is often treated at the time of

After the colonoscopy is complete and you have recovered fully you will be sent home with a summary of your colonoscopy findings and follow up plans. You will need to arrange for a family or a friend to drive you home after the procedure. As you have received sedation for your colonoscopy you should NOT:

  1. Drive after the procedure and for the remainder of the day
  2. Operate machinery
  3. Make major legal decisions

Following your procedure, you it is recommended that you remain with company for the remainder of the day.

Once you are done with your colonoscopy you will be permitted to return to your regular diet. However, it is recommended that you stay away from heavy, fatty or spicy foods for the first 24 hours. You should not drink alcohol until the following day.

It is not unusual to have a sense of bloating and occasional cramps from the air that was used to inflate your colon during the colonoscopy. This feeling should resolve by passing gas. If you are difficulty passing gas you can try drinking warm fluids such as tea or coffee, walking and even a taking a warm bath.

It is normal to have stools that are either soft or liquid stools for the first 24 hours after the procedure with small amounts of blood. If these symptoms do not go away in 24 hours contact either the GHA clinic or your family physician.


If you were informed that you had a biopsy of removal of polyp as part of the colonoscopy and you are on blood thinners such as Aspirin, Plavix, and or Coumadin it is important that you start your blood thinners again as per the instructions of your physician. If you are unsure what you should do please ask the staff at the GHA prior to leaving the clinic.

You may experience bloating and cramps after your procedure. This feeling is caused by the air in your stomach that was inserted during the colonoscopy. Walking, warm fluids and warm bath will help relieve this feeling. Similarly, avoiding certain foods such as legumes, milk products and certain green vegetables such as broccoli for the first 24 hours may be helpful.

It is not uncommon to have small amount to bleeding with your bowel movements. This may appear in the stool, toilet bowel or on toilet paper. This bleeding should resolve within 24 hours. If the bleeding does not stop or the bleeding is more significant in that you are seeing large volumes of blood or clots, you should go to the Emergency room right away.

IF A BIOPSY AND OR A POLYP WAS REMOVED IT IS VERY IMPORTANT THAT YOU KEEP THE FOLLOW UP APPOINTMENT WHICH WAS MADE BY THE GHA CLINIC. The results of your biopsy should be available within 2 weeks. If you have any questions regarding your follow up please do not hesitate to contact the GHA clinic at 905-575-5743


It is very rare for serious complications to occur from a colonoscopy. If you are having:

  1. Severe pain in your stomach and / or discomfort that does not go away or gets worse.
  2. Fever and or chills with a temperature that is greater than 38.5 degrees Celsius or 101.3 degrees F.
  3. Nausea and vomiting
  4. Heavy bleeding with large volumes of blood or clots.

If any of these occur, get a friend and or family member to take you to the nearest emergency room. If you are unable to get someone to drive you, call an ambulance. Remember to bring your colonoscopy report with you.


Flexible Sigmoidoscopy


A Flexible Sigmoidoscope is a small flexible tube that has both a light and a camera. It allows an endoscopist (a specialist trained in endoscopic procedures) to examine the lining of the lower bowel. This includes about two feet of the lower bowel. If necessary, during the procedure, the endoscopist can take tissue biopsies, or remove polyps. The camera allows pictures to be taken that can be stored in a patient medical record.


The most common reasons for flexible sigmoidoscopy are the following:

  • As a screening test to detect colon polyps or colon cancer
  • Blood in the stool or rectal bleeding
  • Persistent diarrhea
  • After radiation treatment to the pelvis when a patient has lower gastrointestinal symptoms
  • Evaluation of the colon in conjunction with a barium enema
  • For the medical management of colitis (inflammation of the colon)

The rectum and lower colon must be completely emptied of stool for the procedure to be performed. One or two enemas prior to the procedure is all that is necessary, but laxatives or dietary modifications may be recommended by your GHA physician in certain instances GHA staff will give you instructions regarding the cleansing routine to be used. If the area to be examined is not clear of stool the endoscopist will not be able to perform an effective examination. Be sure to follow the preparation instructions.


Most of your medications can be continued as usual. However, the use of medication such as aspirin, Vitamin E, nonsteroidal anti-inflammatories, and blood thinners should be discussed with your GHA Physician prior to the examination.

Medications for diabetes may need to be adjusted before the test; talk to your GHA healthcare provider for advice

Instructions for Preparation:
A separate Instruction pamphlet will guide you to the exact steps necessary to be fully prepared for your test. GHA staff will review these instructions with you in detail. CLICK HERE FOR THE LINK


Prior to the procedure:
A nurse will ask questions to be sure that you understand the procedure and the reason it is planned. A doctor will review the procedure, including possible complications, and will review the consent with you.

Flexible sigmoidoscopy usually takes between 5 and 15 minutes. It is performed while you lie on your left side with your legs bent like they would be if you were sitting in a chair. The sigmoidoscope, which is approximately the size of one finger, is inserted into the anus and advanced through the rectum, sigmoid colon, and descending colon. The sigmoidoscope has a camera and a light source that permits the endoscopist to see the inside of the colon on a television monitor.
The endoscope can be used to take biopsies (small pieces of tissue) and to introduce or withdraw fluid or air. Biopsies do not hurt because the lining of the colon does not sense pain. However, you may feel cramping as air is introduced through the scope and as the scope is passed through segments of the colon. The air is needed to permit the endoscopist to advance the scope and see the lining of the colon.
It is common to feel embarrassed about releasing air through your rectum, although this is recommended to decrease discomfort. Let the endoscopist know if there is discomfort, since air can also be removed through the scope.

  • Your GHA Physician will explain the results to you and discuss any findings. If required you will be booked for a follow up appointment.
  • You may have some mild cramping or bloating from the air that was placed into the colon during the examination. This should quickly improve with the passage of gas.
  • You should be able to eat and resume normal activities after leaving the surgeon’s office or hospital.
  • If your Endoscopist sees an area that needs more detailed evaluation during the procedure, a biopsy may be obtained and submitted to a laboratory for analysis. This is done by placing a special instrument through the sigmoidoscope to extract a tiny sample of the lining of the colon. This procedure is painless. If polyps or growths are found, your Endoscopist will usually request that you have a colonoscopy, which is a complete endoscopic examination of the entire colon. A colonoscopy is more suitable to remove polyps and enables the Endoscopist to check the remaining colon for any other polyps or lesions.

Flexible sigmoidoscopy and biopsy are safe when performed by surgeons with appropriate training and experience in endoscopic procedures. Complications are rare, however, they can occur. They include bleeding from the site of a biopsy or a perforation, which is a tear through the lining of the bowel wall. It is important to contact GHA if you notice symptoms of severe abdominal pain, abdominal distension, nausea, fevers, chill, or rectal bleeding equal to more than half a cup. Bleeding can occur up to several days after a biopsy. You may be directed to the nearest Emergency room.


GHA Surgical Centre
726 Upper James Street
Hamilton Ontario
L9C 2Z9

Phone: 905-575-5743
Fax: 905-575-7711




An upper endoscopy is a procedure used to visually examine your upper digestive system with a tiny camera on the end of a long, flexible tube. A specialist in diseases of the digestive system (gastroenterologist/general surgeon) uses endoscopy to diagnose and, sometimes, treat conditions that affect the esophagus, stomach and beginning of the small intestine (duodenum).

The medical term for an upper endoscopy is esophagogastroduodenoscopy. An upper endoscopy can be done in an outpatient surgery center or a hospital. Oftentimes a hospital has a waiting list and may not have anaesthesiologists to give you sedation. An endscopist at the hospital may give you lighter sedation.


Why it’s done

An upper endoscopy is used to diagnose and, sometimes, treat conditions that affect the upper part of your digestive system, including the esophagus, stomach and beginning of the small intestine (duodenum).

Your doctor may recommend an endoscopy procedure to:

  • Investigate symptoms. Endoscopy may help your doctor determine what’s causing digestive signs and symptoms, such as nausea, vomiting, abdominal pain, difficulty swallowing and gastrointestinal bleeding.
  • Diagnose. Your doctor may use endoscopy to collect tissue samples (biopsy) to test for diseases and conditions such as anemia, bleeding, inflammation, diarrhea or cancers of the digestive system.
  • Treat. Your doctor can pass special tools through the endoscope to treat problems in your digestive system.



Endoscopy is a very safe procedure. However it carries a very small risk of complications. Rare complications include:

  • Bleeding. Your risk of bleeding complications after endoscopy is increased if the procedure involves removing a piece of tissue for testing (biopsy) or treating a digestive system problem. In rare cases, such bleeding may require a blood transfusion.
  • Infection. Most endoscopies consist of an examination and biopsy, and risk of infection is low. The risk of infection increases when additional procedures are performed as part of your endoscopy. Most infections are minor and can be treated with antibiotics. Your doctor may give you preventive antibiotics before your procedure if you are at higher risk of infection.
  • Tearing of the gastrointestinal tract. A tear in your esophagus or another part of your upper digestive tract may require hospitalization, and sometimes surgery to repair it. The risk of this complication is very low — it occurs in an estimated 3 to 5 of every 10,000 diagnostic upper endoscopies.

You can reduce your risk of complications by carefully following your doctor’s instructions for preparing for endoscopy, such as fasting and stopping certain medications.

Signs and symptoms that could indicate a complication

Signs and symptoms to watch for after your endoscopy include:

  • Fever
  • Chest pain
  • Shortness of breath
  • Black or very dark colored stool
  • Difficulty swallowing
  • Severe or persistent abdominal pain
  • Vomiting

Call your doctor immediately or go to an emergency room if you experience any of these signs or symptoms.


How do I prepare

Your doctor will give you specific instructions to prepare for your endoscopy. In some cases your doctor may ask that you:

  • Fast before the endoscopy. You may be asked to stop drinking and eating four to eight hours before your endoscopy to ensure your stomach is empty for the procedure.
  • Stop taking certain medications. You may be asked to stop taking certain blood-thinning medications in the days before your endoscopy. Blood thinners may increase your risk of bleeding if certain procedures are performed during endoscopy. If you have chronic conditions, such as diabetes, heart disease or high blood pressure, your doctor will give you specific instructions regarding your medications.

Tell your doctor about all the medications and supplements you’re taking before your endoscopy.


Can I go back to work or drive?

Most people undergoing an upper endoscopy will receive a sedative to relax them and make them more comfortable during the procedure. If you’ll be sedated during the procedure, plan ahead for your recovery while the sedative wears off. You may feel mentally alert, but your memory, reaction times and judgment may be impaired. Find someone to drive you home. You cannot drive for 24 hours. You may also need to take the day off from work. Don’t make any important personal or financial decisions for 24 hours.


What to expect during the procedure

During an upper endoscopy procedure, you’ll be asked to lie down on a table on your back or on your side.


Monitors often will be attached to your body to allow your health care team to monitor your breathing, blood pressure and heart rate. You may receive a sedative medication through a vein in your forearm. This medication helps you relax during the endoscopy. Most people don’t feel or remember anything during or after the procedure.

Your doctor may spray an anesthetic in your mouth to numb your throat in preparation for insertion of the long, flexible tube (endoscope). You may be asked to wear a plastic mouth guard to hold your mouth open. Then the endoscope is inserted in your mouth. Your doctor may ask you to swallow as the scope passes down your throat. You may feel some pressure in your throat, but you shouldn’t feel pain.

You can’t talk after the endoscope passes down your throat, though you can make noises. The endoscope doesn’t interfere with your breathing.

As your doctor passes the endoscope down your esophagus, a tiny camera at the tip transmits images to a video monitor in the exam room. Your doctor watches this monitor to look for abnormalities in your upper digestive tract. If abnormalities are found in your digestive tract, your doctor may record images for later examination.

Gentle air pressure may be fed into your esophagus to inflate your digestive tract so the endoscope can move freely and the folds of your digestive tract are more easily examined. The air can create a feeling of pressure or fullness.

Your doctor will pass special surgical tools through the endoscope to collect a tissue sample or remove a polyp. Your doctor watches the video monitor to guide the tools.

When your doctor has finished the exam, the endoscope is slowly retracted through your mouth. Endoscopy typically takes five to 20 minutes, depending on your situation.

After endoscopy

You’ll be taken to a recovery area to sit or lie quietly after your endoscopy. You may stay for an hour or so. This allows your health care team to monitor you as the sedative begins to wear off.


Once you’re at home, you may experience some mildly uncomfortable signs and symptoms after endoscopy, such as:

  • Bloating and gas
  • Cramping
  • Sore throat

These signs and symptoms will improve with time. If you’re concerned or quite uncomfortable, call your doctor.

Take it easy for the rest of the day after your endoscopy. You may feel alert, but your reaction times and judgment are delayed after receiving a sedative.



When you receive the results of your endoscopy will depend on your situation. If, for instance, your doctor performed the endoscopy to look for an ulcer, you may learn the findings right after your procedure. If a tissue sample (biopsy) was collected, it may take a few days to get results from the testing laboratory. Ask your doctor when you can expect the results of your endoscopy.




The term hemorrhoid is commonly used to describe the symptoms caused by hemorrhoids, since hemorrhoids exist in all healthy persons. Hemorrhoids (HEM-uh-roids), also called piles, are swollen and inflamed veins in your anus and lower rectum. Hemorrhoids may result from straining during bowel movements or from the increased pressure on these veins during pregnancy, among other causes. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids). Hemorrhoids are common ailments. By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids. Fortunately, many effective options are available to treat hemorrhoids. Most people can get relief from symptoms by using home treatments and making lifestyle changes.


Signs and symptoms of hemorrhoids may include:

  • Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet bowl
  • Itching or irritation in your anal region
  • Pain or discomfort
  • Swelling around your anus
  • A lump near your anus, which may be sensitive or painful
  • Leakage of feces

Hemorrhoid symptoms usually depend on the location. Internal hemorrhoids lie inside the rectum. You usually can’t see or feel these hemorrhoids, and they usually don’t cause discomfort. But straining or irritation when passing stool can damage a hemorrhoid’s delicate surface and cause it to bleed. Occasionally, straining can push an internal hemorrhoid through the anal opening. This is known as a protruding or prolapsed hemorrhoid and can cause pain and irritation. External hemorrhoids are under the skin around your anus. When irritated, external hemorrhoids can itch or bleed. Sometimes blood may pool in an external hemorrhoid and form a clot (thrombus), resulting in severe pain, swelling and inflammation.


The veins around your anus tend to stretch under pressure and may bulge or swell. Swollen veins (hemorrhoids) can develop from an increase in pressure in the lower rectum. Factors that might cause increased pressure include:

  • Straining during bowel movements
  • Sitting for long periods of time on the toilet
  • Chronic diarrhea or constipation
  • Obesity
  • Pregnancy
  • Anal intercourse
  • Low-fiber diet

Hemorrhoids are more likely as you get older because the tissues that support the veins in your rectum and anus can weaken and stretch with aging.


Complications of hemorrhoids are rare but include:

  • Anemia. Chronic blood loss from hemorrhoids may cause anemia, in which you don’t have enough healthy red blood cells to carry oxygen to your cells. This may result in fatigue and weakness.
  • Strangulated hemorrhoid. If blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be “strangulated,” which can cause extreme pain and lead to tissue death (gangrene).

Bleeding during bowel movements is the most common sign of hemorrhoids. But rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. Don’t assume that bleeding is coming from hemorrhoids without consulting a doctor. Your doctor can do a physical examination and perform other tests to diagnose hemorrhoids and rule out more-serious conditions or diseases. Also consider seeking medical advice if your hemorrhoids cause pain, bleed frequently or excessively, or don’t improve with home remedies. If your hemorrhoid symptoms began along with a marked change in bowel habits or if you’re passing black, tarry or maroon stools, blood clots, or blood mixed in with the stool, consult your doctor immediately. These types of stools can signal more extensive bleeding elsewhere in your digestive tract. Seek emergency care if you experience large amounts of rectal bleeding, lightheadedness, dizziness or faintness.


Your doctor may be able to see if you have external hemorrhoids simply by looking. Tests and procedures to diagnose internal hemorrhoids may include:

  • Examination of your anal canal and rectum for abnormalities. During a digital rectal exam, your doctor inserts a gloved, lubricated finger into your rectum. He or she feels for anything unusual, such as growths. The exam can give your doctor an indication of what further testing might be appropriate.
  • Visual inspection of your anal canal and rectum. Because internal hemorrhoids are often too soft to be felt during a rectal examination, your doctor may also examine the lower portion of your colon and rectum with an anoscope, proctoscope or sigmoidoscope. These are scopes that allow your doctor to see into your anus and rectum.

Your doctor may want to do a more extensive examination of your entire colon using colonoscopy. This might be recommended if:

  • Your signs and symptoms suggest you might have another digestive system disease
  • You have risk factors for colorectal cancer
  • You’re older than age 50 and haven’t had a recent colonoscopy

Most of the time, treatment for hemorrhoids involves steps which you can take on your own (such as lifestyle modifications). But sometimes medications or surgical procedures are necessary.


If your hemorrhoids produce only mild discomfort, your doctor may suggest over-the-counter creams, ointments, suppositories or pads. These products contain ingredients, such as witch hazel or hydrocortisone, which can relieve pain and itching, at least temporarily. Don’t use an over-the-counter cream or other product for more than a week unless directed by your doctor. These products can cause side effects, such as skin rash, inflammation and skin thinning.

Minimally invasive procedures

If a blood clot has formed within an external hemorrhoid, your doctor can remove the clot with a simple incision, which may provide prompt relief. This is mostly helpful within the first 48 hours. For persistent bleeding or painful hemorrhoids, your doctor may recommend another minimally invasive procedure. These treatments can be done in your doctor’s office or other outpatient setting.

Rubber band ligation. Hemorrhoid Ligation is a procedure during which a latex band is placed around the neck of the hemorrhoid (or pile). The pile then shrinks away over the next couple of weeks. When the hemorrhoid shrinks, there may be some irritation or burning from the raw surface until it heals. For a few days after the procedure patients must avoid excessive coffee, cola, alcohol, spices, heavy lifting and strenuous exercise. Two to four visits will be needed to complete the treatment. A sigmoidoscopy and colonoscopy may be required to ensure there is no other problem higher up causing your symptoms. Most patients with hemorrhoids will have success with this treatment.
Advantages of the Procedure
  • No hospitalizations
  • No general anesthesia
  • Less time lost from work – most patients return to work and resume normal activities the same day
  • Fewer serious complications in this procedure (i.e., no narrowing of the anal opening or serious bleeding, and there is rarely an infection)
  • With this method, the early recurrence rate is reduced to about 15% and late recurrences average about 20%. Hemorrhoids may recur if you strain during bowel movements, sit on the toilet and read, etc.
Post Treatment Precautions and Risks
  • Constipation and straining at stool must be avoided; this is extremely important. If you have this tendency, take natural wheat bran or other bulk forming laxative daily.
  • Bleeding: Spotting may occur when the hemorrhoid shrinks, which is usually minor. Occasionally you may have a gush of blood in the toilet during a bowel movement, in which case do the following.
    • Lie face down on the bed with your stomach over the edge and place your head on a pillow on the floor so that your bottom is as high as possible – for 15-20mins to allow the bleeding to stop by gravity.
    • After that, lie face down on your bed with four pillows under your hips to keep your bottom elevated for an hour. If the bleeding returns, do these steps again. It is very rare (approximately 1 in 1000) that this will not stop the bleeding. If possible, apply lubricated gauze directly. If it continues, please call the clinic.
    • If you experience periodic bleeding after the treatment is over, it is from anal irritation
  • Burning/raw, irritating sensation: Stop all coffee, alcohol, spices (i.e. onions, pepper and garlic)
  • If you are unable to urinate, please call the clinic or go to the nearest emergency department at a hospital. A urinary catheter may (rarely) need to be inserted at the hospital.
  • Local infection or abscess formation may rarely happen.
  • Injection (sclerotherapy). In this procedure, your doctor injects a chemical solution into the hemorrhoid tissue to shrink it. While the injection causes little or no pain, it may be less effective than rubber band ligation.
  • Coagulation (infrared, laser or bipolar). Coagulation techniques use laser or infrared light or heat. They cause small, bleeding, internal hemorrhoids to harden and shrivel. While coagulation has few side effects, it’s associated with a higher rate of hemorrhoids coming back (recurrence) than is the rubber band treatment.
Surgical procedures

If other procedures haven’t been successful or you have large hemorrhoids, your doctor may recommend a surgical procedure. Surgery can be performed on an outpatient basis or you may need to stay in the hospital overnight.

  • Hemorrhoid removal. During a hemorrhoidectomy, your surgeon removes excessive tissue that causes bleeding. Various techniques may be used. The surgery may be done with a local anesthetic combined with sedation, a spinal anesthetic or a general anesthetic. Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications may include temporary difficulty emptying your bladder and urinary tract infections, postoperative bleeding and rarely incontinence. Most people experience some pain after the procedure. Medications can relieve your pain. Soaking in a warm bath also may help.
  • Hemorrhoid stapling. This procedure, called stapled hemorrhoidectomy or stapled hemorrhoidopexy, blocks blood flow to hemorrhoidal tissue. Stapling generally involves less pain than hemorrhoidectomy and allows an earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Talk with your doctor about what might be the best option for you.

You can often relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments. Often these are the only treatments needed.

  • Use topical treatments. Apply an over-the-counter hemorrhoid cream or suppository containing hydrocortisone, or use pads containing witch hazel or a numbing agent.
  • Soak regularly in a warm bath or sitz bath. Soak your anal area in plain warm water 10 to 15 minutes two to three times a day. A sitz bath fits over the toilet. You can get one at most drugstores.
  • Keep the anal area clean. Bathe (preferably) or shower daily to cleanse the skin around your anus gently with warm water. Soap isn’t necessary and may aggravate the problem. Avoid alcohol based or perfumed wipes. Gently dry the area with a hair dryer after bathing.
  • Don’t use dry toilet paper. To help keep the anal area clean after a bowel movement, use moist towelettes or wet toilet paper that doesn’t contain perfume or alcohol.
  • Apply cold. Apply ice packs or cold compresses on your anus to relieve swelling.
  • Take oral pain relievers. You can use acetaminophen (Tylenol, others), aspirin or ibuprofen (Advil, Motrin, others) temporarily to help relieve your discomfort.

With these treatments, hemorrhoid symptoms often go away within a week. See your doctor if you don’t get relief in a week, or sooner if you have severe pain or bleeding.


The best way to prevent hemorrhoids is to keep your stools soft, so they pass easily. To prevent hemorrhoids and reduce symptoms of hemorrhoids, follow these tips:

  • Eat high-fiber foods. Eat more fruits, vegetables and whole grains. Doing so softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids or worsen symptoms from existing hemorrhoids.
  • Drink plenty of fluids. Drink eight to ten glasses of water and other liquids (not alcohol, not caffeinated) each day to help keep stools soft.
  • Consider fiber supplements. Most people don’t get enough of the recommended amount of fiber — 25 grams a day for women and 38 grams a day for men — in their diet. Studies have shown that over-the-counter fiber supplements, such as Metamucil and Citrucel, improve overall symptoms and bleeding from hemorrhoids. These products help keep stools soft and regular. Your local pharmacist would be a great resource to help you select the best fiber supplement for you. If you use fiber supplements, be sure to drink at least eight glasses of water or other fluids every day. Otherwise, the supplements can cause constipation or make constipation worse.
  • Don’t strain. Straining and holding your breath when trying to pass a stool creates greater pressure in the veins in the lower rectum.
  • Go as soon as you feel the urge. If you wait to pass a bowel movement and the urge goes away, your stool could become dry and be harder to pass.
  • Exercise. Stay active to help prevent constipation and to reduce pressure on veins, which can occur with long periods of standing or sitting. Exercise can also help you lose excess weight that may be contributing to your hemorrhoids.
  • Avoid long periods of sitting. Sitting too long, particularly on the toilet, can increase the pressure on the veins in the anus.



Anusitis or pruritis ani is the irritation of the skin around the anal opening, causing symptoms such as pain, burning, itching and blood visible on the toilet paper. Anusitis is rarely related to hemorrhoids, but is most commonly due to irritation of the anal canal caused by acidic foods in the diet. This results in a discharge to the outside that is extremely irritating to the anal skin. Stress may alter your dietary habits but is not the direct cause of anusitis. Smoking is not a cause of anusitis.

In order to stop the symptoms, the anusitis must be controlled. Methods of treatment will help improve the symptoms but long-term improvements can only be achieved if the causes are eliminated.


Diet is the main cause of anusitis. In decreasing order of importance, try
avoiding the following from your diet:

  1. Coffee
  2. Beer
  3. Red wine
  4. Garlic
  5. Pizza
  6. Italian sauces
  7. Curry
  8. Carbonated drinks, including soda water and Perrier
  1. Citrus fruits and juices (orange, grapefruit and lemon)
  2. Cranberry juice
  3. Iced tea
  4. Apple juice
  5. Chocolate
  6. Nuts
  7. Popcorn
  8. Red meat (except veal)
  9. Fatty meats (especially pork)
  1. Strawberries and fruits with seeds
  2. Hot peppers
  3. Chili
  4. Excesses of vinegar, black pepper and tomatoes

The ideal way to identify the causes of the problem is to go on a strict diet for 3 weeks and then reintroduce the foods you eliminated every 2 to 3 days, one food at a time. You should notice returning symptoms within 24 to 48 hours.

Safe foods to consume while on the diet are: Tea, Water, Milk, White Wine, Chicken, Fish, Meat, Rice, Potatoes, Vegetables, Breads, Cereal, Eggs, Cheese and Bananas.

Bowel Habits:

One to three large, soft, regular bowel movements each day is ideal. A higher fiber diet along with more water (6-8 glasses/day) may be necessary to achieve this goal (refer to Bowel Habit instruction sheet). Avoid taking mineral oil, and take laxatives only if absolutely necessary. Use glycerine suppositories just before a bowel movement if you expect a hard stool.

Anal Hygiene:

Do not use coloured toilet paper after a bowel movement. Try using large balls of cotton batting, first to wipe, then to wash and finally to pat dry. Ideally you should have a shower after each bowel movement – use a mild soap (i.e. Aveeno). If this is not possible, then use Tucks (non-prescription) to clean after a bowel movement.


Use Tucks at other times as well when there is an anal irritation and discharge. Cornstarch powder can be applied liberally and may help. Finally, use the Anurex if symptoms are severe. Anurex, a cold reusable suppository, helps relieve irritation by quickly soothing the area by cooling. Other suppositories and some skin creams may also help, but do not work as effectively. During treatment, every effort should be made to keep the anal skin as clean and dry as possible.

Note: Miscellaneous:
  • Never scratch! Cut your nails short and file them daily with an emery board. Scratching during your sleep just perpetuates the vicious cycle.
  • Prevent moisture in the anal area by applying cornstarch two to six times daily. Lay a cotton ball with cornstarch powder over the anal opening. Use it before and after perspiring i.e. jogging, golfing, etc. Do not use Vaseline or oily ointments.
  • It is imperative that the whole cycle of rectal irritation, discharge and anal moisture followed by scratching be broken. The pruritus will disappear if no other pathology is present. If not, further investigation and treatment is necessary.
  • Keep on the diet and medication until long after your feel better or the problem may recur. If excessive spices, alcohol, etc. are consumed within the six months after symptoms are gone, use Anurex that night and the next one to prevent a recurrence. Anurex will last for nine months.



What is it?

Helicobacter pylori (H. pylori) is a helical shaped Gram-negative bacterium that infects various areas of the stomach and duodenum. Many cases of peptic ulcers, gastritis, duodenitis, and perhaps some cancers are caused by the H. pylori infection. However, many who are infected do not show any symptoms of the disease.

What are the Symptoms?
  • Stomach pain
  • Nausea or vomiting
  • Heartburn
  • Diarrhea

Symptoms may be worse before or after meals. One third of the people who are infected never have any symptoms. By middle age, 50% of adults have been infected with H. pylori bacteria.

Diagnosis of Infection

Diagnosis of infection is usually made by checking for dyspeptic symptoms and then doing one of the following tests which can suggest H. pylori infection:

  • A non-invasive blood antibody test
  • A stool antigen test
  • A carbon Urea Breath Test (in which the patient drinks 14C or 13C– labeled urea, which the bacterium metabolizes producing labeled carbon dioxide that can be detected in the breath).
  • However, the most reliable method for detecting H. pylori infection is a biopsy check during endoscopy with a rapid urease test, histological examination, and microbial culture.
Treatment of Infection

In peptic ulcer patients where infection is detected, the normal procedure is the eradication of H. pylori to allow the ulcer to heal. The standard first-line therapy is a one week triple therapy. Today, the standard triple therapy is amoxicillin, clarithromycin and a proton pump inhibitor such as omeprazole.

A meta-analysis of randomized controlled trials suggests that supplementation with probiotics can improve eradication rates and reduce adverse events.

Unfortunately, an increasing number of infected individuals are found to harbor antibiotic-resistant bacteria. This results in initial treatment failure and requires additional rounds of antibiotic therapy or alternative strategies such as a quadruple therapy. Bismuth compounds are also effective in combination with the above mentioned drugs. For the treatment of clarithromycin-resistant strains of H. pylori the use of levflaxacin as part of the therapy has be suggested.

Helicobacter and cancer

While the incidence of H. pylori infection in humans is decreasing in developing countries, presumably because of improving sanitation and increasing use of antibiotics, in the United States the incidence of gastric cancer has decreased by 80% from 1900 to 2000. This apparent correlation is consistent with an epidemiological link between H. pylori and cancer. Specifically, both gastric cancer and gastric MALT lymphoma (lymphoma of the mucosa-associated lymphoid tissue) have been associated with H. pylori. Nonetheless, among bacteria suspected to cause cancer, H. pylori is the leading contender.



Irritable Bowel Syndrome (IBS) is a disruption of the intestinal tract. Its symptoms include abdominal pain, bloating and abnormal bowel movements. Diarrhea may often alternate with constipation, while pain and bloating may be relieved by a bowel movement. With IBS, nerve endings in the bowel are unusually sensitive, which means even normal bowel events such as passing fluid or gas cause abnormal muscle reactions.

IBS is known as a functional disorder as there is no direct cause of the syndrome. Symptoms appear to be caused by contraction of your bowel muscles. The contraction results from increased sensitivity within the bowel to almost anything: eating, stress, emotional arousal or gaseous distension.

Approximately 10-20% of adults experience the symptoms of IBS. Its symptoms are the second most common cause of workplace absenteeism, after the common cold. Its impact differs between people because of their alternating constipation and diarrhea. However, with some simple lifestyle changes, those same people say that their lives are back to normal.

People who have had IBS often say they felt like their life revolved around the bathroom because of their alternating constipation and diarrhea. However, as mentioned previously, with some simple lifestyle changes, those same people say that their lives are back to normal.


It has been established that 10% of people who suffer from IBS get better each year. Of course, this will be affected by your lifestyle and stress levels but you have the ability to control the symptoms of IBS.

Changing diets will help many people with IBS, but it varies from person to person. Caffeine, nicotine and/or alcohol and foods such as dietary fats should be avoided as these are common triggers of your symptoms. However, any food can trigger your IBS symptoms. Learning what is right and wrong is the best way to minimize the effects of IBS and maximize the benefits of your diet. Generally, adding bran or another natural source fibre, like the psyllium in Metamucil, to your diet can help to relieve the constipation associated with IBS.

Here are a few tips to help treat IBS:
  • Take some time to evaluate your eating habits and levels of stress, as this is important in minimizing IBS symptoms.
  • Try to increase dietary fibre and avoid foods that trigger your symptoms. Also, remember to drink at least 8 glasses of fluid per day.
  • Avoid or develop coping mechanisms for stress. Stress may be triggered by overwork, poor sleep habits or personal difficulties.
  • Proper balance between rest and exercise can help reduce stress levels and help with IBS.



Constipation is a frequent complaint. This can be mild (small, hard stools) to severe (no bowel movements without a laxative).

Constipation is almost always due to insufficient fibre intake because our foods are so highly refined that there is little fibre left. Our forefathers ate about 60g of fibre per day; we eat only about 13g daily. Most of us need about 20-35g per day or more. One to three soft, formed stools a day is normal.

Canada’s dietary guidelines: Recommendation of fibre intake with different ages and sexes:
Men 19 to 50 38
Men 51 and older 30
Women 19 to 50 25
Women 51 and older 21
Pregnant Women 19 and older 28
Breastfeeding Women 19 and older 29

There are two types of fibre: insoluble and soluble. Soluble fibre is absorbed into the blood stream and is of no help to the bowel. The best source of insoluble fibre is cereal, but very few are truly high in fibre. In order to achieve better bowel habits, we suggest the following:

  • Fibre 1 or All-Bran Cereals
    Please check the label to be sure the fibre content is close to 15g per serving. Be sure to drink a glass of water while you are eating it and another one afterwards. If necessary, you can eat another bowl of cereal in the evening. That alone would give you 30g of fibre per day. Some bloating may occur but this just means that the bowel is starting to work. It should subside in time.
  • High Fibre Bread (Prairie Bran has 6g per two slice servings)
  • Other foods high in insoluble fibre content include most beans, brussel sprouts, corn, peas, acorn squash, potatoes with the skin on, blackberries, and raspberries.

Always drink a glass of water whenever you have fibre. Fibre does not work without water. Coffee or juice does not help! If your bowel movements tend to become too frequent or loose, decrease the amount of fibre, as every individual’s needs are different.

Some additional points to note:


  • Wheat Bran 1-4 tbsp (green Quaker box) may be added to the above cereals or put in meatloaf etc. Remember to drink water with it!
  • If you wish to lose some weight, have cereal and water 30mins before your main meal
  • Avoid white bread and other cereals with low fibre content
  • Fibre is an invisible chemical, not a stringy material that you can see
  • There is no upper limitation for fiber consumption
  • Avoid supplements and laxatives with Cascara or Senna



1.How long will the procedure take?

The procedure itself takes approximately 30 minutes. However, expect to be at the clinic for up to 2 hours due to the time required to complete registration, pre-operative preparation and recovery.

2.Can I drive home after my procedure?

You are going to be sedated and as a result you will not be able to drive until the following morning. Also do not go back to work after the procedure.

3.Can I stay awake during the procedure?

Physicians recommend sedation. It is makes it more comfortable and easier for both you and the physician. However, if you absolutely wish to have no sedation, you have that option. Should you choose “no sedation”, it will be noted on your consent and in your report.

4.Can a friend or family member stay with me during the procedure?

Unfortunately not – as only patients are allowed in the endoscopy suite. Your friend/family member will have to remain in the waiting area. Should you need assistance with regards to dressing/undressing or for translation, please inform the nurse prior to your procedure.

5.Can I take a taxi home?

You are permitted to take a taxi home ONLY if you are accompanied by someone or have someone accompany you when you arrive home.

6.How can I fast for so long if I am a diabetic?

We recommend you book an early morning appointment to reduce the time required to fast. We may bring a snack with you to have after your procedure is completed. Please consult your physician on how to take your diabetic medications and insulin the day before and the day of the procedure.

7.Should I continue to take my medications/vitamins prior to my procedure?

You may take your blood pressure, heart medications, asthma and epilepsy in the morning with a small sip of water. Diabetic patients will need special instructions from their doctor.

8. Can I still have my procedure if I am menstruating?

You can still have your procedure but ask that you wear either a tampon or pad.

9.Do I have to take the bowel prep – I had a bad reaction last time/or it tastes awful?

The physician prefers you complete the prep as directed. Should your colon not be clean on the date of your appointment, the procedure will be cancelled and we will need to rebook your procedure.

If you have a sensitive stomach or get nauseated, you may take Gravol 50 mg tablet 30 minutes prior to starting your preparation.

10. Will I see physician before and after my procedure?

Yes. The physician will describe the procedure to you prior to beginning. After your procedure is completed, the physician will provide you with a written report on how the procedure went.

11. Why do I need a consultation before my procedure?

Given your specific circumstances, a consultation is required before your procedure? (ie. age, medical conditions and time of last scope)

12. Do the physicians see children?

No. The physicians only see patients 18 years of age or older. Children should be seen by a paediatric gastroenterologist and should have their procedure performed at a hospital.

13. What is the difference between doing the procedure at the hospital vs. the clinic?

The wait time for a procedure in a hospital is usually much longer.