Int J Colorectal Dis (2002) 17:402–411 DOI 10.1007/s00384-001-0389-9 Accepted: 21 December 2001 Published online: 7 March 2002 © Springer-Verlag 2002 Abstract Background and aims: To assess the effect on irritable bowel syndrome (IBS) of treating ano-rec- tal problems by applying multiple Barron’s bands to prolapsing mucosa and excising haemorrhoids, with or without a low lateral sphincterotomy. Patients and methods: 144 patients with IBS whose ano-rectal abnor- malities were treated by a single consultant surgeon. A prospective ‘within person’ study of consecutive patients referred with ano-rectal problems who also had IBS symp- toms according to the Rome criteria. All patients completed structured questionnaires about anal and IBS symptoms before operation and 6–60 months later. The findings were compared with those from pa- tients who had no abdominal pains. Results: The principal IBS symp- toms of abdominal pain, abdominal distension, and altered bowel habit all improved significantly after oper- ation. Those with persistent anal problems had more problems with persistent IBS symptoms, but when the anal problems were corrected, the IBS tended to settle. Posterior anal tenderness is present in 80% of IBS patients and is a useful diagnos- tic sign. Conclusions: This work suggests that in many patients with IBS there is a physical ano-rectal disorder amenable to physical treat- ment. Patients with IBS should all be proctoscoped carefully, with and without the patient straining, looking for abnormalities. Correcting muco- sal prolapse and other anal problems produced an improvement in IBS symptoms in 86% of patients. This suggests that ano-enteric reflexes are a significant factor in irritable bowel syndrome, if not the major cause. Keywords Haemorrhoids · Fissures · Surgery · Irritable bowel syndrome ORIGINAL ARTICLE Bernard V. Palmer W. John Lockley Robert B. Palmer Elena Kulinskaya Improvement in irritable bowel syndrome following ano-rectal surgery Introduction It is a medical truism that where there are many differ- ent treatments, the disease is not understood properly. Nowhere is this more the case than for irritable bowel syndrome (IBS). It has been estimated that 10–25% of otherwise healthy persons in Western countries suffer from IBS [1,2]. The major symptom of lower abdomi- nal pain is probably due to colonic spasm as screening of barium enemas has demonstrated a correspondence between peristaltic contraction in the colon and the usual pain [3]. It has also been suggested that bowel atony is largely caused by increased sympathetic activ- ity [4]. What could initiate these reflex spasms or atony? Stress is well known to alter intestinal function in normal persons [5], and this can be exacerbated in patients with IBS [6]. Many studies have shown that mood and per- sonality disturbances are all more common in IBS pa- tients [7]. However, persons with IBS who do not con- sult their physician appear to have psychological profiles that are similar to those without symptoms [8], and therefore it has been suggested that the psychoneurosis is in part secondary to the bowel symptoms [9]. B.V. Palmer ( ✉ ) 39 Pasture Road, Letchworth, SG6 3LR, UK e-mail: bernardpalmer@ntlworld.com Tel.: +44-1462-683064 Fax: +44-1462-643872 B.V. Palmer Lister Hospital, Corey’s Mill Lane, Stevenage, SG1 4AB, UK W.J. Lockley Health Centre, Oliver Street, Ampthill, MK45 2SB, UK R.B. Palmer 36 Sunlight Square, Birkbeck Street, London E2 6LD, UK E. Kulinskaya H.R.D.S.U., University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK