Anorectal symptoms and conditions are common and may be caused due to a range of conditions. however, due to lack of awareness and fear of embarrassment patients hesitate from seeking medical help. Common anal conditions, if ignored, may cause severe implications and therefore one should always consult a specialist in case of persistant symptoms.
1. ANAL FISTULA
What is Anal Fistula?
Anal fistula, or fistula-in-ano, is a common anorectal problem in which an abnormal connection develops between the inner surface of the anal canal and the skin around the anal verge thereby causing severe pain and infection.
Why does Anal Fistula occur?
Anal glands located between the two layers of the anal sphincters (muscles which open and close the anal orifice) and draining into the anal canal are the site where these fistulae originate. It is the blockage of the outlet of these glands which cause secretions to accumulate inside and an abscess can form which can eventually point to the skin surface. The tract formed by this process is the fistula.
What is Minimally Invasive Anal Fistula Treatment (MAFT)?
Minimally Invasive Anal Fistula Treatment technique is a major breakthrough treatment option for complex fistulas.
In this technique we first examine the fistula path with an endoscope and determine the point of the internal opening of the fistula. Then the internal opening of the fistula is closed with the help of stapler and the entire path of the fistula is destroyed by electrocautery under direct telescopic vision.
There is no surgical wound in the perianal region hence no dressings needed. The risk of faecal incontinence is negligent because no sphinter damages occur. The procedure is done under spinal anesthesia/ general anesthesia. There is minimal post-operative discomfort thereby reducing the time of recovery.
What are piles?
Piles or hemorrhoids are swollen blood vessels in the anal passage. There are two circular bunches of veins, one inside the anal canal and the second at the anal verge. Accordingly they are called internal and external hemorrhoids
Why do piles develop?
There are certain conditions which predispose to formation of piles. These are
Ø Excessive straining while passing stools e.g. chronic constipation, low fibre diet, poor bowel habits
Ø Increased backward pressure on pelvic blood vessels e.g. Pregnancy, pelvic tumors
Diagnosis is usually done by direct examination and proctoscopy. A colonoscopy may sometimes be advised if a mass lesion or other pathology is suspected in the colon.
We follow the minimally invasive technique for treatment.
Advantages of Minimally Invasive procedures for Piles
Ø Minimal post operative pain
Ø Much faster recovery
Ø Shorter hospital stay
Ø Less post operative discomfort
Ø No dressings
Ø Early resumption of normal activities
3. ANAL FISSURES
What is an anal fissure?
An anal fissure is a small tear or cut in the skin at the anal opening. Fissures typically cause pain and often bleed. Fissures are quite common, but are often confused with other causes of pain and bleeding, such as hemorrhoids. Most fissures occur along the mid-line - the top or bottom - of the anus.
What are the symptoms of an anal fissure?
The typical symptoms of an anal fissure are pain during or after defecation and fresh bleeding. The pain may be severe enough to cause the patients to avoid defecation.
What causes an anal fissure?
Ø Injury: Most commonly due to a hard, dry bowel movement. Many women during childbirth develop an anal fissure
Ø Digital insertion (during examination)
Ø Foreign body insertion
Ø Anal intercourse
A fissure may also develop following diarrhea or inflammatory conditions of the anal area.
How can a fissure be treated?
The principle of treating an anal fissure is relieving the anal spasm and correcting the constipation. At least 50 percent of anal fissures heal by medical management alone.
Ø Drinking more fluids.
Ø Eating a high-fiber diet to avoid constipation.
Ø Using stool softeners.
Ø Allowing enough time for a bowel movement
Ø Sitz baths (soaking anal area in plain warm water)
Ø Avoid foods that may not be well-digested (i.e., nuts, popcorn, tortilla chips)
Ø Topical ointments
Medical treatment of an acute anal fissure may take a few days or weeks, while healing of a chronic anal fissure may take more than 6 weeks.
In case a fissure does not heal should be reexamined to determine if an underlying problem exist that prevents healing.
4. RECTAL PROLAPSE
What is rectal prolapse ?
A condition where in the rectum (distal most part of large intestine just above the anal canal) protrudes out of the anal opening due to stretching or disruption of its attachments to the posterior abdominal wall.
Causes of rectal prolapse?
The primary cause of rectal prolapse remains unclear. Predisposing factors include:
Ø Prolonged straining while passing stools (chronic constipation)
Ø Multiple pregnancies
Ø Neurological illnesses causing muscular weakness or connective tissue disorders (genetic predisposition)
It is often seen in the elderly as aging causes the supporting ligaments to stretch the anal sphincter muscle to weaken.Diagnosis of rectal prolapse is made on history and physical examination. In case of an internal rectal prolapse sometimes a defecography is required.
How is Rectal Prolapse Treated?
Rectal prolapse occurring in children, during pregnancy and following childbirth are known to correct spontaneously and most often do not require any intervention. In most cases however surgery is required to correct rectal prolapse in adults and in some children. There are 2 procedures described for repair of rectal prolapse- Perineal Approach and Abdominal Approach.
Both procedures can be performed by Laparoscopic approach.