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INFORMATION

Cancer surgery of digestive apparatus and the colorectal surgery unit team of Ruber International Hospital offer the diagnostic and therapeutic most innovative services to patients afflicted of colon, rectum and anus disorders or diseases; as well as the primary cancer or metastasis from liver, stomach and pancreas.  This Unit physicians have a wide experience and a prestigious recognition in these pathologies treatment, as at a national level as international granted by the academic assets and the years of professional practice.

WHAT DO WE TREAT?

Colorectal surgery area

Colon functional disorders
Referred to symptoms not caused by a proved disease and that, therefore, are attributed to an abnormal functioning of colon, either by excess or default, causing diarrhea, constipation, or alternation of both situations and disturbances due to gases. As a whole they are known as irritable bowel syndrome or irritable colon syndrome. In any type of functional disorder are evident or hidden signs of bleeding. Its correct study is essential to discard other diseases that could disclose similar symptoms. The treatment is symptomatic, and assuming certain measures related with habits and diet. Patients with this diagnosis are informed in writing about all the resources to fight the symptomatic effects of this process.
• Irritable colon syndrome.
• Constipation.
• Chronic diarrhoea.
• Tympanites.
Rectum and anus functional disorders

Rectum and anus functional disorders

Anal incontinence:
It affects, in different levels, to a high percentage of the population, especially from a certain age. Its causes can be several: congenital origin, due to the partial or total absence of the anal sphincter; obstetrics, due to tears during childbirth; traumas, due to accidental injury of the sphincter or after certain surgeries; neuropaths, due to injuries or pudendal nerve atrophy supplying the external sphincter; and also, due to unknown causes, affecting to a relatively significant group of multiparous women without manifesting a direct lesion of the muscle or nerve. In the most mild cases, the treatment is to adapt the diet, astringent medication and pelvic floor exercises reinforcing musculature and improving the anus-rectum sensation, known as biofeedback. This is the choice when the incontinence is secondary to a sphincter lesion that can be surgically repaired. When the sphincter is not repairable, or when repair failed, or when there is no sphincter, more complex techniques must be applied as a reproduction of a new sphincter with other muscles or by an artificial sphincter implant. If the muscle is unaffected, but it does not work properly, the most successful current technique is the sacral neuromodulating, which also will repair the urinary incontinence and it is performed with local anaesthesia and sedation. Our group gathers the widest personal experience in Spain in the diverse techniques, and it is recognized internationally by its works in this pathology.
Constipation due to outflow obstruction
The study of constipation is complex, since it can obey many causes and, generally it is produced by several of them. The hidden rectal prolapse, the enterocele, the rectocele and the anismus are pathologies very frequents, especially in woman. These ones could become a severe constipation due to the emphraxis to faeces exit, which is not responding to the laxatives treatment and is causing a huge suffering. In certain cases, as the called anismus, which is the sphincter contraction instead of normal relaxation at the voluntary moment of an attempted defecation, the solution is by biofeedback techniques. Nevertheless, in prolapse case, enterocele or rectocele, the treatment is surgical through techniques by perineum, abdomen, open tracts or laparoscopy. In not responding to conventional treatments cases, the sacral neuromodulating is an emerging technique with encouraging results in a selected group of patients.

Anus-rectum chronic pain
It is one of the more frequent functional pathologies which treatment is multidisciplinary due to not quite well known causes. Generally it is solved with conservative measures. It can be necessary to use sacral neuromodulating techniques for the not responding cases. Our team has a large experience in the treatment of anal incontinence.

Pruritus ani
The anal chronic itching is the cause of a deep distress and can result in injuries originating new problems and stressing itching. Its study and treatment are sometimes very complex; it requires having specific protocols, which could involve the help from other specialists.

Benign organic colon pathology

Diverticular disease
Inflammatory bowel desease: Crohn and ulcerous colitis:
Both pathologies imply a great complexity. There have been significant advances in latest years in the medical handling of the new anti-inflammatories and immunomodulators, requiring the treatment and follow-up of these patients by specialized units involving the work together of gastroenterologists and surgeons. In the surgical ield, the stenoplastic technique is the disease of Crohn, to avoid the short bowel syndrome, and the anus preserving techniques after the colon and rectum scission or containing ileostomy in ulcerous colitis have implied a radical change in the patients’ prospects and quality of life. We are able to offer a wide experience in ileonal reservoir techniques due to have been pioneers in Spain.
Polyps and bowel polyposis syndrome
The polyps in large bowel is one of the more common pathologies in the western world, affecting increasingly a percentage of the adult population from 50 years old. Its relevance is because known polyps as adenomatous are indications of the 95% of colon and rectum cancers. Left to its natural evolution, we know that approximately one of the three adenatous polyps, initially benign, will end up by degenerating into a cancer. Therefore, the detection in asymptomatic phase and the endoscopic scission of such a type of polyps is the essential aspect to avoid the colorectal cancer. Therefrom the need to perform a colonoscopy to all the people showing blood in faeces, although this blood comes from another more common pathology as haemorrhoids and, to people older than 50 presenting some risk factor. The endoscopic polypectomy is a routine technique in a Coloproctology Unit. Occasionally, there are benign polyps that, due to its size, cannot be resected endoscopically and it is necessary to operate. There is highly valued significance the cases of this type of benign tumors in the rectum, since, with certain surgical techniques, which require a high specialization, they can be resected through the anus without the need of more aggressive surgeries and more risked.
Polyposis syndromes are related to hereditary particular diseases that, from the second decade of life, start developing themselves hundred and sometimes thousand polyps in the digestive tract, especially in colon and rectum. In these cases it is necessary to resect all the colon and rectum before one or various of these polyps become malignant, what would happen in the 100% of cases if it is not treated in this way. Fortunately this surgery can be performed conserving the anus, rebuilding a neo-rectum with the small bowel so that the patients do not need to have an artificial anus called ilestomy. Our group has a wide surgical experience in such procedures.
Moreover, it is relevant to ease the corresponding genetic information to the diagnosed patient’s brothers and sisters to identify in advance those who have inherited the disease, what it is possible by a blood test. Our unit works together with the Genetic Service engaged with the European registry of hereditary polyposis.

Benign pathology of rectum and anus

Benigh tumors.
Anal fistulae: Fistulae are one of the most common anal diseases. The 95% of them are caused as a consequence of a node infection into the anus. Its origin and prevention are unknown. The initial infection phase is produced in a pus collection which is spontaneously or surgically drained through the skin around the anus. Once there is an infection remittance, an open anal orifice through there is a small chronic suppuration, or even it can be seen the gases and faeces elimination, as this external orifice and the internal orifice are communicated. The internal orifice is equivalent to the node that caused the infection. Anal fistulae treatment can be very complex as it has anatomic characteristics, since the fistula tracks go through the muscles that allow the anal continence, the sphincters. Its lesion involves the development of a incontinence in a greater or lower degree, depending on the spread of the injured muscle. Hence, it is necessary to be familiar with this anatomy to be able to perform healing techniques without aftermaths. Generally, such techniques are only performed by specialized units as ours.
Rectovaginal fistulae: They entail a direct connection between the rectum and the vagina, resulting in the involuntary frequent faeces and flatulence emission through the vagina. The causes may be several, the obstetric trauma during childbirth and a local infection are the more commons. They imply one of the most difficult treatments for an anal surgeon, and, frequently even require the building of an artificial temporary anus that in a 15% of cases becomes permanent. There are several surgeries for solving it, according to the cause and circumstances of each particular case, some of them extremely complexes. There are only few units with experience in its treatment or with a significant number of cases. Our Unit has recently compiled the mentioned experience in a prestigious in coloproctology speciality and mass media international magazine for its publication, which is one of the biggest series printed to current days.
Vesicovaginal fistulae: Although it is a rare disorder in the western world, its appearance is dramatic for women, since it provokes a continuous emission of urine through the vagina. Its treatment is highly complex. Our experience in this type of fistulae comes from a program developed and performed by members of our Unit for its prevention and treatment in certain African countries, where, due to its frequency, there is a social-sanitary impact.
it is the most common anal pathology. They can only be treated if there are symptoms. The internal ones generally are bleeding, and the more spread out current treatment among specialised groups is the placement of elastic ligatures, this procedure is achieved outpatient and without anaesthesia, it is painless. The ligated haemorrhoids are detached in 7 or 10 days, and the 70% of treated patients do not need any further treatment; a 20% could have new bleedings through other haemorrhoids not previously ligated, then they will need a new ligature session; and a 10% will need a third one. External haemorrhoids generally provoke symptoms of annoyances as burning, itching, or pain if they are inflamed. Its treatment is always surgical. There are different techniques but, which are currently more used in specialized units are the simple hemorrhoidectomy, or open or closed, and the hemorrhoidopexy or circular mucosectomy with a stapler when a mucous prolapse is related. Any technique advocating the practice of laser as advantageous tool compared to the electric scalpel, in terms of type of anaesthesia as pain and postoperative recovery, is misleading according to greatly shown in the scientific studies of evidence-based authority.

Chronic anal fissure: it is an anal disorder also quite common, of unknown origin, which main symptom is pain when defecating. Its medical treatment comprises the local and long application of nitroglycerine ointment or the injection in the internal anal sphincter of botulinum toxin. Frequently those treatments fail or are given up by the patient. The surgery is the internal lateral sphincterotomy, which is of the performed with local anaesthesia or without sedation. The definitive healing is in the 99% of cases. Its medical treatment comprises the local and long application of nitroglycerine ointment or the injection in the internal anal sphincter of botulinum toxin.
Anal incontinence from congenital or trauma origin: muscular sphincter reconstructions or by artificial anal sphincter implant. It affects in different degrees to a high percentage of the population, particularly from a certain age. Its causes can be several: congenital origin, due to the partial or total absence of the anal sphincter; obstetrics, due to tears during childbirth; traumas, due to accidental injury of the sphincter or after certain surgeries; neuropaths, due to injuries or pudendal nerve atrophy supplying the external sphincter; and also, due to unknown causes, affecting to a relatively significant group of multiparous women without manifesting a direct lesion of the muscle or nerve. In the most mild cases, the treatment is to adapt the diet, astringent medication and pelvic floor exercises reinforcing musculature and improving the anus-rectum sensation, known as biofeedback. This is the choice when the incontinence is secondary to a sphincter lesion that can be surgically repaired. When the sphincter is not repairable, or when repair failed, or when there is no sphincter, more complex techniques must be applied as a reproduction of a new sphincter with other muscles or by an artificial sphincter implant. If the muscle is unaffected, but it does not work properly, the most successful current technique is the sacral neuromodulating, which also will repair the urinary incontinence and it is performed with local anaesthesia and sedation. Our group gathers the widest personal experience in Spain in the diverse techniques, and it is recognized internationally by its works in this pathology.

Colorectal cancer

It is the second more recurrent tumor in men and women in the occidental world. Its prevention is very simple, as the 95% are developed from a benign adenatous polyp. Our Unit is highly specialized in the preventing and treating concerns, as with local resection techniques as the radical surgery, these last ones with or without preserving sphincters. The members of the Unit are authors of several publications thereon in renowned international magazines, specialized books, dissertations and rewarded research studies; in official recognition to one of them as “expert in colorectal cancer in the European Union”.
Preventing:
The following risk groups are submitted to a colonoscopy:
-Asymptomatic individuals with family backgrounds of colorectal cancer in first-degree relatives, from the age of 50 or ten years before the age of your relative’s age cancer.
-Any individual referring the observance of blood in faeces or in drops on having defecated, whatever the age. Although it seems evident to suffer another more common pathology as haemorrhoids, since in a percentage of them, one or more adenomatous polyps will be found. If they are not resected, it might degenerate into a cancer in the future.
-Everyone with history of having had adenomatous polyps.
-Women who have or have been operated of gallbladder calculi.
– To women with breast cancer background.

-To those have been already cured from a colorectal cancer; since in all these group of people, the possibilities to suffer a colorectal cancer or to develop a second cancer are higher than for the population without that risky background. The prevention is also carried out resecting the colon and the rectum of the patients with family adenomatous polyposis and, in patients with ulcerous colitis of more than 10 years of evolution showing dysplasia signs in biopsy.
It is the second more recurrent tumor in men and women in the occidental world. Its prevention is very simple, as the 95% are developed from a benign adenatous polyp. Our Unit is highly specialized in the preventing and treating concerns, as with local resection techniques as the radical surgery, these last ones with or without preserving sphincters. The members of the Unit are authors of several publications thereon in renowned international magazines, specialized books, dissertations and rewarded research studies; in official recognition to one of them as “expert in colorectal cancer in the European Union”.
Local treatment preserving sphincters: Its indication is for identified rectum tumors and above all suspiction to be spread out to the lymphatic nodes after the preoperative studies of staging. The surgery is accomplished through the anus and requires being familiar with the procedure so that the resection becomes healing without damaging the sphincters and avoiding the incontinence disorders.
It is the second more recurrent tumor in men and women in the occidental world. Its prevention is very simple, as the 95% are developed from a benign adenatous polyp. Our Unit is highly specialized in the preventing and treating concerns, as with local resection techniques as the radical surgery, these last ones with or without preserving sphincters. The members of the Unit are authors of several publications thereon in renowned international magazines, specialized books, dissertations and rewarded research studies; in official recognition to one of them as “expert in colorectal cancer in the European Union”.
Radical treatment-intraoperative radiotherapy: excluding the above mentioned cases in that the healing is possible with conservative techniques of local scission, the colorectal cancer surgery must be radical regarding the appropriate surgical resection of the bowel segment container of the tumor, together with all the lymphatic nodes that could be overrun and the surrounding areas to the tumor if they already are. This involves a high technical specialization in this pathology, and the occasional cooperation of other specialists if necessary, since it is widely and scientifically proven that the healing possibilities are greater if such tumors are operated by an expert group. It is indicated the performance of preoperative or intraoperative radiotherapy for particular cases. For this purpose, our hospital offers the latest resources, always achieving the interdisciplinary treatment, with the collaboration of the diverse oncology units. Likewise, it is really important the correct and sensible follow up to the potentially healed patient, as the early diagnosis of a loco-regional, hepatic or pulmonary recurrence, allows healing treatments in an increasingly proportion of patients.

Stomas

The handling and care of stomas, colonostomy or ilestomy is usually simple, but it requires a basic training. In our unit works a stomatherapist who provides these training to the patients and his closest relatives, helping them in their homes if necessary. In addition, he teach them the colostomy irrigation technique and the usage of the obturator, hence it is not necessary to hold the bag until the next irrigation because the colostomy will not issue faeces except for prompt and rare circumstances. Then, it works as a continent abdominal colostomy. Special reference deserve particular surgical techniques mentioned in the following:
Continent ileostomy of Kock: by this technique, to apply an ileostomy bag in the skin is avoided. It means to build a reservoir in the final segment of the small bowel, by an abouchement to the skin by a valve duct of the bowel itself emerging from the reservoir and flat shaped sutured in the low part of the abdomen skin, in a way that is almost hidden in the suprapubic area. Hereof, the bowel content is being collected in the reservoir (the generated valve prevent the exit to outside) until the patient himself is intubated by a simple and painless manoeuvre to proceed to its emptying sat in the toilet. This is done every six hours with regard to the night rest hours. The technique requires expertise in ileal reservoir making and in the valve structure, in addition to the initial training for the intubation by a stomatherapist. The indications are mainly for young patients, with ulcerous colitis or hereditary polyposis, with previous resection of anus and conventional ileostomy carriers.
Abdominal colostomy restructuring to continent perineal colostomy: by these complex techniques the anus can be reconstructed, to make a new rectum and to restore a new sphincter to modify a patient’s unwished abdominal colostomy, and to restore the flatulencies and faeces elimination through the perineum, reaching continence good levels or extremely good. The authors have described an original procedure to accomplish this objective and they gather a wide experience with each one of the mentioned surgical techniques individually.

Cancer

Colorectal cancer:
Referred to symptoms not caused by a proved disease and that, therefore, are attributed to an abnormal functioning of colon, either by excess or default, causing diarrhoea, constipation, or alternation of both situations and disturbances due to gases. As a whole they are known as irritable bowel syndrome or irritable colon syndrome. In any type of functional disorder are evident or hidden signs of bleeding. Its correct study is essential to discard other diseases that could disclose similar symptoms. The treatment is symptomatic, and assuming certain measures related with habits and diet. Patients with this diagnosis are informed in writing about all the resources to fight the symptomatic effects of this process.
It is the second more recurrent tumor in men and women in the occidental world. Its prevention is very simple, as the 95% are developed from a benign adenatous polyp. Our Unit is highly specialized in the preventing and treating concerns, as with local resection techniques as the radical surgery, these last ones with or without preserving sphincters. The members of the Unit are authors of several publications thereon in renowned international magazines, specialized books, dissertations and rewarded research studies; in official recognition to one of them as “expert in colorectal cancer in the European Union”.
Prevention: The following risk groups are submitted to a colonoscopy:
-Asymptomatic individuals with family backgrounds of colorectal cancer in first-degree relatives, from the age of 50 or ten years before the age of your relative’s age cancer.
-Any individual referring the observance of blood in faeces or in drops on having defecated, whatever the age. Although it seems evident to suffer another more common pathology as haemorrhoids, since in a percentage of them, one or more adenomatous polyps will be found. If they are not resected, it might degenerate into a cancer in the future.
-Everyone with history of having had adenomatous polyps.
-Women who have or have been operated of gallbladder calculi.
– To women with breast cancer background.
-To those have been already cured from a colorectal cancer; since in all these group of people, the possibilities to suffer a colorectal cancer or to develop a second cancer are higher than for the population without that risky background. The prevention is also carried out resecting the colon and the rectum of the patients with family adenomatous polyposis and, in patients with ulcerous colitis of more than 10 years of evolution showing dysplasia signs in biopsy.
Local treatment with sphincters protection: It is the second more recurrent tumor in men and women in the occidental world. Its prevention is very simple, as the 95% are developed from a benign adenatous polyp. Our Unit is highly specialized in the preventing and treating concerns, as with local resection techniques as the radical surgery, these last ones with or without preserving sphincters. The members of the Unit are authors of several publications thereon in renowned international magazines, specialized books, dissertations and rewarded research studies; in official recognition to one of them as “expert in colorectal cancer in the European Union”.
It is the second more recurrent tumor in men and women in the occidental world. Its prevention is very simple, as the 95% are developed from a benign adenatous polyp. Our Unit is highly specialized in the preventing and treating concerns, as with local resection techniques as the radical surgery, these last ones with or without preserving sphincters. The members of the Unit are authors of several publications thereon in renowned international magazines, specialized books, dissertations and rewarded research studies; in official recognition to one of them as “expert in colorectal cancer in the European Union”.
Radical treatment-intraoperative radiotherapy: excluding the above mentioned cases in that the healing is possible with conservative techniques of local scission, the colorectal cancer surgery must be radical regarding the appropriate surgical resection of the bowel segment container of the tumor, together with all the lymphatic nodes that could be overrun and the surrounding areas to the tumor if they already are. This involves a high technical specialization in this pathology, and the occasional cooperation of other specialists if necessary, since it is widely and scientifically proven that the healing possibilities are greater if such tumors are operated by an expert group. It is indicated the performance of preoperative or intraoperative radiotherapy for particular cases. For this purpose, our hospital offers the latest resources, always achieving the interdisciplinary treatment, with the collaboration of the diverse oncology units. Likewise, it is really important the correct and sensible follow up to the potentially healed patient, as the early diagnosis of a loco-regional, hepatic or pulmonary recurrence, allows healing treatments in an increasingly proportion of patients.
Local treatment preserving sphincters: Its indication is for identified rectum tumors and above all suspiction to be spread out to the lymphatic nodes after the preoperative studies of staging. The surgery is accomplished through the anus and requires being familiar with the procedure so that the resection becomes healing without damaging the sphincters and avoiding the incontinence disorders.

Liver cancer:
The great advance in latest years with the hepatic transplant, has allowed to reach new boundaries in cancer surgery, inthinkable not long ago, as for primary, as in the most frequent cases of secondary metastasis to a colorectal cancer or from other origin. Thus, it is possible to resect with postoperative successful and healing warranties of part of these lesions. One of the Unit members is co-manager of the Hepatic Transplantation Unit in one of the public hospitals with more activity of this surgery nationwide. Therefore he has a proven experience in this type of high specialized surgeries. Such operations only must be performed by surgeons who own this technical knowledge both for the correct patients’ selection as for its performance in hospitals, with the suitable and more innovative resources.

Stomach cancer:
The surgery of stomach cancer has greatly evolved in the last years thanks to the cancer expertise and the capabilities of performing technically surgeries of maxim radicalism with complete eradication of all the lymphatic drainage areas; as well as for the innovation in immediate postoperative cares and in nutrition. This has led to the capability of doing resections with healing purpose in a greater range of patients. These procedures, as in other aspects of innovative surgery, must be performed by highly experienced surgeons in digestive oncological surgery and in centers who provide the best resources for a complete postoperative care. A member of our team meets one of the current widest casuistries in Spain.
Pancreas cancer:
There are few specialists with a current experience in the surgical treatment of these lesions because they are rather uncommon and technically complex. It seems proved that the intraoperative radiotherapy can improve the results in selected patients, therefore, as with the rest of digestive tumors, its treatment must be performed by surgeons who master all this oncologic surgical areas and in centers who provide additional services to reach the highest radicalism. This professionality is offered by our group, since one of its members is a referenced surgeon in this pathology in one of the biggest public hospitals in Madrid.

MEDICAL TEAM

Dr. Devesa Múgica, José Manuel Team leader
Más información

Dr Múgica

Formación de Postgrado

  •  Clínica Puerta de Hierro, Madrid.
  • Thomas´ Hospital, Londres,UK.
  • The Royal Marsden Hospital, Londres, UK.
  • Lahey Clinic, Boston, USA.
  • Mayo Clinic, Rochester, USA.

 

Premios,  Publicaciones y Conferencias

  •  Varios primeros premios de Investigación Clínico-Quirúrgica.
  • Más de 150 publicaciones.
  • 59 como primer autor en revistas nacionales e internacionales
  • 15 Capítulos de Libros / Monografías.
  • casi 300 conferencias en España y muchos países del mundo de todos los continentes.

 

Autor de Técnicas Quirúrgicas originales en:

  •  Incontinencia Anal.
  • Síndrome de Intestino Corto.
  • Reconstrucción Anal tras Amputación del Recto.

 

Comités y Nombramientos

  •  Miembro Fundador del Board Europeo de Coloproctología y examinador del Board. Presidente de la Asociación Española de Coloproctología.
  • Presidente de Honor de la Asociación Española de Coloproctología.
  • Miembro de Honor de la Academia Española de Medicina y Cirugía.
  • Miembro de Honor de la Asociación de Coloproctología de Chile.
  • Miembro de Honor de la Asociación de Coloproctología de Ecuador.
  • Miembro del Comité de Expertos en Cáncer de Colon y Recto de la Comisión de las Comunidades Europeas.
  • Miembro Fundador de la Eurasian Colorectal Technologies Association.
  • Miembro del Comité Editorial de Techniques in Coloproctology.
  • Presidente de la Mediterranean Society of Coloproctology.

 

Patentes

 Dispositivo de cerclaje anal para la incontinencia: Incostop

 

Idiomas

Inglés, Francés (hablado y escrito)

SERVICES PORTFOLIO

Therapeutic and diagnosed endocopy

High digestive endoscopyIt is to insert an optic tube through the mouth to examine the esophagus, stomach and duodenum.
Through this technique biopsies can be performed and the Helicobacter pylori infection can be investigate which is the responsible bacteria of most of gastric ulcerations and duodenum. With this examination also can be done oesophagic dilatations or polyp resections.

Colonoscopy

It consist in inserting an optic tube through the anus and it is indicated to examine from the rectus to the caecum, it is a more complex technique than the previous one, more annoying for the patient who often requires pharmacological sedation.
It is performed with a flexible device that moves forward the colon by an air inflation. It has mechanisms letting to flex when passing by the different angulations of the colon. This procedure is indicated in patients with familiar background of cancer or colon polyps and it is the chosen to diagnosis mucous colon diseases, as inflammatory bowel diseases. One of the more important indications fits the hypoferric anaemia diagnosis and in all the clinical cases of a suspecting colon cancer. The examination also allows the polyps removal without surgery.

Functional tests

Manometry It entails the determination of pressures generated by the anal inner and outer sphincters, idle and when a voluntary contraction of the anus is produced as required by the doctor in charge of the test. By them the complete functionality of both sphincters is known, what is a really important matter to keep the continent. The examination is absolutely painless and it does not requires previous preparation. It is mainly indicated for the incontinence study and to prevent it in cases where the patient must be submitted to anal surgeries that could damage the sphincters.

Anus-rectum sensibility study

It is simultaneously done with the manometry as its addition, for incontinence and constipation cases. It entails to determine when the rectum sensation is perceived by inserting a balloon that is being progressively inflating. It is also to determine when the expulsion desire is felt and, in its easiness or difficulty produced. The test is also painless. The anal sensibility is studied provoking an automatic response in the sphincter.

These tests are done by the Neurophysiology Unit of the Neurology Service. They are annoying studies, with a limited use to special incontinence cases, in which this information is necessary to determine the best treatment or to partially forecast the results.

Video echography

It is a functional radiologic study carried out by the Radio-diagnosis Service, and that, in this hospital is a national reference center for this test. It is mainly indicated for the severe constipation study not responding to a dietary measures and with regular laxatives. It involves to insert a papilla into the rectum simulating the faecal bolus. By starting the removal process and during, all the rectum and sphincter movements can be recorder, this allows to know the causes that are impeding the evacuation. The procedure is painless and it requires a basic bowel preparation.

Functional treatment of the incontincence and constipation

Biofeedback
Involves the conditional learning to reach a more efficient contraction or the relax of the pelvic floor muscles . The main indications are for treating minor degrees of anal incontinence or to reinforce the surgical treatment results; for treating particular cases of constipation which evolve greatly difficult to evacuate although feeling the desire to do it; and for certain cases of anus-rectum pain of unknown origin which do not drop to other more conventional treatments. The biofeedback sessions are performed by one of the Unit doctors, who holds a wide experience in such treatments.
Ambulatory Anal Surgery
A high percentage of not complex anal surgery is treated on a outpatient basis. This issue is openly communicated to the patients to the patients to who are informed about the advantages.