Anal fissures
An anal fissure is a small tear in the skin that lines the opening of the anus. Fissures typically cause severe pain and bleeding with bowel movements. Fissures are quite common in the general population but are often confused with other causes of pain and bleeding, such as hemorrhoids.
Symptoms
Anal fissures typically cause a sharp pain that starts with the passage of stool. This pain may last several minutes to a few hours. As a result, many patients may try not to have bowel movements to prevent the pain.
Other symptoms include:
- Bright red blood on the stool or toilet paper after a bowel movement
- A small lump or skin tag on the skin near the anal fissure (more common when chronic or has been present for greater than 6 weeks).
Treatment
Surgical treatment is recommended in chronic anal fissures and failure of conservative treatment. It involves the resection of the stretch with the use of laser or diathermy and most of the time the simultaneous partial medial-lateral sphincterotomy of the internal anal sphincter. In the hands of an experienced anal surgeon is a surgery that does not cause complications.
It is a completely painless, bloodless procedure, performed under general or epidural anesthesia and the patient leaves the
clinic on the same day. The results are impressive as the stretch mark pain subsides greatly from the first day and the patient returns to activities immediately.
Hemorrhoids
Hemorrhoids are when the veins or blood vessels in and around your anus and lower rectum become swollen and irritated. This happens when there is extra pressure on these veins. About 50 percent of adults experience the symptoms of hemorrhoids by the age of 50.
Hemorrhoids can either be internal or external. Internal hemorrhoids develop within the anus or rectum
External hemorrhoids develop outside of the anus.
External hemorrhoids are the most common and most troublesome. Hemorrhoids cause pain, severe itching, and difficulty sitting. Fortunately, they’re treatable.
Causes
Hemorrhoids occur when there’s too much pressure on the veins around your anus. Possible factors include:
- straining during a bowel movement
- complications from chronic constipation
- sitting for a long period, especially on the toilet
- a family history of hemorrhoids
Risk factors
Hemorrhoids can be passed on genetically from parent to child, so if your parents had hemorrhoids, you’re more
likely to get them. Consistent heavy lifting, obesity, or other constant strain on your body can increase your risk for hemorrhoids.
You’re also more likely to develop hemorrhoids if you’re pregnant. When the uterus enlarges, it presses on the vein in the colon, causing it to bulge.
Symptoms
- Often strain during bowel movements
- Have a family history of hemorrhoids
- Are older
- Have long-term or chronic constipation or diarrhea
Treatment
Hemorrhoidectomy
Surgery to remove hemorrhoids is called hemorrhoidectomy. The doctor makes small cuts around the anus to slice them away.
You may get local anesthesia (the area being operated on is numb, and you’re awake though relaxed) or general anesthesia (you’re put to sleep). Hemorrhoidectomy is often an outpatient procedure, and you can usually go home the same day.
Because it’s highly sensitive near the cuts and you might need stitches, the area can be tender and painful afterward.
Recovery most often takes about 2 weeks, but it can take as long as 3 to 6 weeks to feel like you’re back to normal.
Procedure for Prolapse and Hemorrhoids (PPH)
PPH is also called a stapled hemorrhoidectomy. The doctor will use a stapler-like device to reposition the hemorrhoids and cut off their blood supply. Without blood, they’ll eventually shrivel and die.
It can treat hemorrhoids that have and have not prolapsed or slipped down out of the anus.
This procedure moves hemorrhoids to where there are fewer nerve endings, so it hurts less than a traditional hemorrhoidectomy. You’ll also recover faster and have less bleeding and itching. And there are generally fewer complications.
Hemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR)
Hemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) is a new procedure in which a miniature Doppler sensor is inserted in the anus to detect the arteries supplying blood to hemorrhoids.
The surgeon can pinpoint the arteries supplying the hemorrhoids and can tie them off to cut the blood supply. The hemorrhoids are reduced almost immediately and within weeks, are no longer noticeable. The procedure is effective and virtually painless.
Anal fistulas
An anal fistula is a tunnel that runs from inside the anus — the hole your body uses to get rid of solid waste — to somewhere in the skin around it. It usually follows an infection that didn’t heal the right way. Your doctor can repair the fistula, but you’ll need surgery for that.
Symptoms
- Pain
- Redness
- Swelling around your anus
- Bleeding
- Painful bowel movements or urination
- A foul-smelling liquid oozing from a hole near your anus
Treatment
There are several stages to treating an anal fistula:
Definitive treatment of a fistula aims to stop it from recurring. Treatment depends on where the fistula lies, and which parts of the internal and external anal sphincters it crosses.
- Fistulotomy
- Cutting seton
- Seton stitch
- Fibrin glue injection
- Laser surgery
Anal abscesses
An anal abscess is a condition in which a cavity in the anus develops an infection and fills with pus.
Symptoms
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- Pain, which is usually constant, throbbing, and worse when sitting down.
- Skin irritation around the anus, including swelling, redness, and tenderness.
- Discharge of pus.
- Pelvic inflammatory diseaseConstipation or pain associated with bowel movements.
Causes
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- An anal fissure, a tear in the anal canal, that becomes infected
- Sexually transmitted infections
- Blocked anal glands
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Risk factors
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- Colitis
- Inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis
- Diabetes
- Diverticulitis
- Being the receptive partner in anal sex
- Use of medications such as prednisone
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Treatment of Anal Abscesses
Prompt surgical drainage is important, preferably before the abscess erupts.
Sometimes, fistula surgery can be performed at the same time as abscess surgery. However, fistulas often develop four to six weeks after an abscess is drained. Sometimes a fistula may not occur until months or even years later. So fistula surgery is usually a separate procedure that can be performed on an outpatient basis or with a short hospital stay.
After abscess or fistula surgery, discomfort is usually mild and can be controlled with pain medications
