In a series focusing on medical specialisms, Theresa Porrett talks about treating bowel and related disorders.
Looking at patients holistically
Coloproctology is the branch of medicine looking at diseases and disorders affecting the colon, rectum, and anus.
WHAT IS YOUR JOB?
I am a nurse consultant in coloproctology based at Homerton University Hospital NHS Foundation Trust, London.
I provide nurse-led services for people with a range of bowel problems.
I am also part of a colorectal nursing research unit at a nearby university.
WHAT IS THE MOST COMMON CONDITION?
The most common conditions I manage are those resulting from constipation; anal fissures (a tear in the skin around the anus) and haemorrhoids.
These conditions are associated with poor bowel and toilet habits.
Poor toilet habits include a huge range of behaviours ranging from forcing your bowels open at the same time each day even though you feel no urge to go, to avoiding the call to stool because it's not convenient and then straining later when you again have no urge to go.
Others include poor positioning on the loo, or sitting for a while reading the paper and straining.
My role is to educate and empower patients so they are able to improve their bowel and toilet habits and, in the majority of cases, cure the problem themselves.
Although perceived as benign and therefore minor conditions, they mainly affect young adults and can be associated with significant social and work inconvenience and embarrassment.
Bowel cancer is the second most common cancer in the UK, so we see patients with this condition on a regular basis.
As nurse specialists, our key role is that of patient support - from their initial investigation and diagnosis of bowel cancer, to treatment and long-term follow-up.
WHAT IS THE MOST COMMON PROCEDURE?
Nurse consultants can undertake many invasive procedures such as sigmoidoscopy - where a rigid tube with a light source is inserted into the anal canal and rectum to look for abnormalities, flexible sigmoidoscopy - where a flexible tube with integral camera is used and haemorrhoids injections.
But I would consider that the most common procedure I undertake is not the physical examination of the patient, but an individual assessment of the patient and the development of a personal advice, information and education package.
WHAT IS THE HARDEST THING ABOUT YOUR JOB?
The hardest and most challenging part of my role is the constant review of the services we provide, asking myself 'if this was me or a member of my family is this what I would want, is this how I would wish to be treated?'
I think the challenge of working in today's NHS is to ensure that the patient, not the organisation, remains at the centre of the services you provide.
There is a risk that management initiatives can become the focus of service provision and not the patient.
WHAT IS YOUR MOST SATISFYING CASE?
I feel it every time a person says to me 'the problem has resolved, you have cured it' and I can remind them that, by changing their lifestyle and taking on board the information and advice I have given them, they have cured the problem for themselves.
And every time a patient says 'I was dreading coming to hospital about this problem because it's so embarrassing but you have really put me at ease'.
WHY DID YOU CHOSE THIS SPECIALITY?
When I qualified as a nurse there were very few specialist nurses working in this area. Jobs in intensive care or cardiac surgery were perceived as having much more acceptability and status.
I considered that bowel problems, with their associated stigma and embarrassment, were seen as 'the poor relation' and I wanted to try to do something about that.
IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALITY?
No, I love the area in which I work, the daily contact with patients, getting to know them as individuals
I have a very strong sense of doing what I am meant to be doing - fate I suppose.
HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?
I hope that there will continue to be the development of specialist nursing roles to support patients with bowel cancer, incontinence, inflammatory bowel disease, those who have stoma (an artificial opening to or from the intestine) and those with functional bowel disorders.
Without a doubt the nursing profession will develop the research and audit aspect of its work, ensuring that we deliver evidence-based care to patients.
CV - Theresa Porrett
1982: Qualified as a Registered General Nurse (or SRN as it was
then!) having trained at The Princess Alexandra School of Nursing, The Royal London Hospital, Whitechapel
1987: Became a ward Sister at St Marks Hospital , London (a specialist
1991: Clinical Nurse Specialist in Stoma Care, Homerton Hospital
2003: Nurse Consultant in Coloproctology, Homerton Hospital