Colorectal Consultant led clinics occur on a weekly basis at Southmead Hospital Bristol.

Procedures performed in the Outpatients Clinic include:

• Rigid sigmoidoscopy,
• Rubber band ligation of haemorrhoids,
• Endoanal ultrasound.

Endoscopy services occur on both trusts sites weekly, this is supported by a full range of radiology services.

Conditions Treated:

• Colorectal diseases
• Colon and rectal cancer,
• Inflammatory bowel disease (colitis and Crohns disease),
• Diverticular disease,
• Colostomies and ileostomies,
• Anorectal disorders (haemorrhoids, fissure, fistula, rectal prolapse, faecal incontinence).
• Hernias.

Colorectal Nurse Specialist Service

The service encompasses support, advice and empowering patients and their families to make decisions with regard to the different treatment options. This support is offered from diagnosis throughout the patient’s disease trajectory.

The aim of the Colorectal Nurse Specialist team is to provide support and information to patients and their families at the point of suspected and confirmed diagnosis of colorectal cancer throughout their care. The Colorectal Nurse Specialists also provide nurse-led follow up for patients who have been diagnosed with colorectal cancer at North Bristol NHS Trust. 

How is ME/CFS diagnosed?

There are no specific tests to diagnose ME/CFS but there are clear guidelines to help with making a diagnosis. These guidelines include:

• Blood tests – these will be done by your GP and are used to screen out other health conditions that can cause fatigue and related symptoms, for example, anaemia, or an underactive thyroid. A diagnosis of ME/CFS can be considered if the blood test results don’t suggest other causes for the fatigue.
• Medical history – this will involve asking you about when your symptoms started and whether there were any specific triggers leading up to the onset of your illness such as an infection, stress, surgery, a trauma or perhaps a gradual decline in your health.
• Symptoms – these are descriptions of how you are feeling, and the clinician will also ask how the symptoms impact on your daily activities, work and social life, and sleep. ME/CFS is characterised by a wide range of symptoms, not just fatigue, and in order to make a diagnosis of ME/CFS a certain number of these symptoms also need to be present.

It is important to note that ME/CFS is not a condition that is diagnosed just by a ‘process of elimination’ when another medical reason for the fatigue/illness cannot be identified or explained. M.E. is a very specific syndrome with a clearly defined range of symptoms and associated problems. There are also instances where people may be unwell with an unexplained cause but where ME/CFS can be ruled out by a ME/CFS specialist.

Who might I see in the Bristol M.E. Service?

Having ME/CFS can affect many areas of everyday life such as work, activities, sleep and relationships. Managing ME/CFS effectively needs a wide range of skills. This is why we have different types of therapists in our team, including physiotherapists, occupational therapists and psychologists. Each clinician can work in partnership with people living with ME/CFS to improve their self-management skills, reduce the suffering caused by ME/CFS, increase wellbeing and improve quality of life.  Although the clinicians are specialists in each of their chosen areas, they have a high level of knowledge of the other specialties and there is significant overlap in the areas covered by each clinician.

Having ME/CFS means that people aren’t able to do as much as before. We offer support to people in managing activities to get the best quality of life possible despite having ME/CFS. This might involve looking at ways to level out activities, and we can offer support with slowly increasing activities. We can also offer specialist advice regarding issues relating to work (both paid and voluntary work) and study. ME/CFS affects fitness, stamina and mobility, and may affect balance and co-ordination. We consider the person as a whole, and we can offer individually tailored exercise and physical activity programs to maintain general health and mobility, and these programs can lead to improved mobility for some people living with ME/CFS. We can also support people in making changes to their sleep patterns, which can take some time to improve. 

Living with ME/CFS can understandably lead to increased stress levels, feelings of helplessness or a sense of loss of control, as well as lower mood. Often people notice strong emotions such as fear, anger, frustration, and guilt. It is also common for people who have been feeling unwell for a long time to develop set ways of coping that are unhelpful, such as self-criticism. We know that ME/CFS isn’t ‘all in the mind’, however self-critical patterns of thinking can complicate the management of ME/CFS. The routines and habits that we develop throughout our lives can be difficult for anyone to change but we can help with this. We offer support in developing self-management strategies for ME/CFS and use a range of methods and techniques including a specialist form of Cognitive Behavioural Therapy (CBT) to support coping, relaxation training and also an approach known as Mindfulness which we have adapted for people living with ME/CFS.

Do special diets for people with ME/CFS help?

The British Dietetic Association produce a useful guide to dietary issues and ME/CFS that you can download from here: https://www.bda.uk.com/resource/chronic-fatigue-syndrome-diet.html
This guide is based on the best available evidence relating to ME/CFS and diet.

A significant number of people with ME/CFS also have Irritable Bowel Syndrome (IBS), which can be helped by specific diets. You can find out more information about diet and IBS from the British Dietetic Association website: https://www.bda.uk.com/resource/irritable-bowel-syndrome-diet.html
 

We aim to help patients and their doctors to identify the condition, and then offer support to manage it as effectively as possible.

We can help to reduce some of the symptoms using medication and other approaches, but many people face the challenge of living with these ongoing symptoms for some time. We know that ME/CFS can gradually improve in many people, and the support that we offer can increase the likelihood of progress. We also know that learning ways to manage the condition can help people to make improvements in quality of life. For example, many patients experience a delayed increase in symptoms a day or two after an increase in activity levels. This is known medically as “post-exertional malaise” but it is known to many of our patients as “payback”. This delayed response can make the illness particularly difficult to manage. Through learning self-management skills, people can reduce the likelihood and severity of this “payback”. This can provide a more stable situation which allows some patients to slowly build up important activities.

What happens when you first visit the Bristol M.E. service?

We accept referrals from GPs and hospital specialists. Once we have checked the appropriate tests have been completed by your GP, you will be sent some questionnaires to fill in: these form the basis of the initial assessment. We send them to you so that you have a chance to think about the questions before the appointment, so hopefully the appointment is not so demanding. The appointment will be with one of the team: a psychologist, physiotherapist or occupational therapist who will discuss your symptoms and the impact of your symptoms on your day to day to life. During this appointment we may diagnose ME/CFS, but sometimes it is necessary to make a second appointment.

Following diagnosis, a management plan is agreed: often this can include a further individual appointment or taking part in one of our multidisciplinary therapy groups. Our Service offers a multidisciplinary approach, in line with the NICE guidelines. We regularly monitor newly published research into ME/CFS, but at present there are a limited number of evidence-based treatments for ME/CFS. Three guides to therapies have been produced by the British Association of Clinicians in ME/CFS (BACME). There is a guide to symptom management, a guide to therapy and also a guide offering advice for people who are severely affected by ME/CFS To find out more about these guides, visit https://bacme.info/

We often see people who have developed M.E./CFS following an infection, such as glandular fever. Other people can identify a period of stress leading up to the start of their illness. A combination of infection and stress is also common. Occasionally, it starts without an obvious trigger.

Researchers are gradually developing insights into how the condition develops and the changes which take place in the body as a result of illness. However, this picture is far from complete at present.

A more detailed summary of the current evidence can be found at the Centers for Disease Control and Prevention website www.cdc.gov/me-cfs/about/possible-causes.html

There is been a gradual increase in research into M.E./CFS over the years, especially in the past decade. Some of this research was looking for a single "broken part", as is common with medical research. It's a bit like taking your car to the garage: you expect them to find out what's wrong, take the broken part out and fix it. This approach has led to some insights but more recently researchers have been looking at the behaviour of systems in the body and finding that they don't behave normally, particularly after an exercise challenge. This shift of focus in the research is likely to be more helpful. It's more like having a problem with a modern car, taking it to the garage, and finding that they identify a problem with the software which is stopping it from running smoothly. You can find a webinar delivered by the British Association for Clinicians in M.E. (BACME) which puts together a lot of these ideas in this Youtube video.

Consultant Plastic Surgeons at NBT

Miss Rachel Clancy

Mr Thomas Chapman

Miss Giulia Colavitti

Mr Thomas Wright

Consultant Oncologists at UHBW

Dr Gareth Ayre

Dr Adam Dangoor

Dr Timothy Spencer

Clinical Nurse Specialists

Christine Millman

Rebecca Peach

Sally Lovell

Consultant Radiologists

Dr Brathanban (Ben) Rajayogeswaran

Dr Edward Walton

Extended Core Members North Bristol NHS Trust (Urology)

Mr Salah Albuhessi

Mr Ahmed Mahrous

University Hospital Bristol and Weston NHS Foundation Trust (Thoracics)

Miss Eveline Internullo

Mr Doug West

Consultant Histopathologists

Dr Naomi Carson

Dr Francesca Maggiani

Dr Demetris Poyiatzis

Sarcoma Cancer Support Worker

Hannah Hilton

Patient Pathway Coordinators

Charlotte Brown (Plastic Surgery)

Lisa Groves (Plastic Surgery)

Gemma Flook (Urology)

MDT Coordinator

Amy Dixon

Cancer information session

Cancer Support Worker

Macmillan Wellbeing Centre

Bristol Haematology and Oncology Centre (BHOC)

Cancer Research UK

My Medical Record

Penny Brohn

Patient information leaflets

© North Bristol NHS Trust. This edition published January 2025. Review due January 2028. NBT003764

British Association of Spine Surgeons, visit www.spinesurgeons.ac.uk

British Scoliosis Society, visit www.britscoliosissoc.org.uk

Eurospine, visit www.eurospine.org

The Scoliosis Research Society, visit www.srs.org

AO Spine, visit www.aospine.org

The Bristol Neurological & Spinal Unit provides a Clinical Fellowship for up to one year for a senior surgical trainee wishing to pursue a career in spinal surgery. 

Previous Spinal Fellows have come from either a Neurosurgical or Orthopaedic background. 

There are also opportunities for both UK and international fellows to visit the respective departments of Orthopaedics or Neurosurgery to gain further experience within these sub-specialties. 

For further information regarding the Senior Clinical Spinal Fellowship please contact Mr John Hutchinson Consultant Orthopaedic Surgeon on Mr Nitin Patel.

The Bristol Neurological & Spinal Unit has a strong reputation for innovation and groundbreaking research in relation to spinal conditions. Examples of clinical research include:

•  Development and evaluation of new instrumentation to treat paediatric spinal deformity
• Motion preserving spinal technologies such as cervical disc replacements
• Image guided spinal surgery
• Minimally invasive spinal surgery
• Neuro-modulation for chronic pain 
• Investigations into the causes of adult onset spinal deformity

The Bristol Neurological & Spinal Unit also has strong research links with the University of Bristol Department of Anatomy, University of the West of England, the University of Bath Department of Biomechanical Engineering, as well as close links with the Bristol Institute of Clinical Neurosciences.