Understanding anorectal problems


  Fortunately, most bottom problems can be solved without surgery. But, that does not mean we avoid seeking professional advice, because, even though problems do settle down naturally, understanding them will help prevent recurrence and unnecessary anxiety.

One of the common anorectal conditions is Piles. Piles are pathological swellings of normal vascular structures in the anal canal. In their physiological state, these vascular structures act as cushions composed of arterio-venous channels and connective tissue that aid the passage of the stool. The symptoms of haemorrhoids depend on the degree and type. Most piles can be treated conservatively by medical treatment itself and does not require surgery.

Today, we have many options to treat piles such as Cryosurgery, Infra-red coagulation, Laser, Doppler Ligation etc. A new and radical change in the treatment of haemorrhoids in the recent times has been MIPH — Minimally Invasive Procedure for Haemorrhoids or Stapled Haemorrhoidopexy. This technique is increasingly being done today and has the merits of lesser pain, lesser time to recover and early return to work by most patients.

Fissure is another  very common anal condition that causes an amount of suffering out of proportion to the size of the lesion. Most superficial fissures may heal spontaneously in a week or two especially if motions are kept soft and constipation is avoided. Recurrent fissures and chronic fissures may present with a swelling around the fissure and is called a sentinel tag. 

Surgery for fissure is reserved for those who do not respond to medical treatment.

Fistula is the Latin word for ‘pipe’. In surgery, it means an abnormal tract connecting two surfaces, i e, the skin around the anus and the internal anal canal/rectum. Most fistulae in ano develop because of an abscess in the ano-rectal region which has been allowed to burst spontaneously or has been inadequately opened.

Surgery is required for treatment of fistula. However, recurrence after fistula is very well known. Carcinoma of the rectum and anus present as painless or painful bleeding in stools and closely mimics  piles or fissure. Hence, it is imperative to do an examination of the anal canal and rectum in all patients who present with such symptoms. An early disease can be cured.

Dr Rajeev Premnath,
Day Care Surgeon
Ramakrishna Hospital

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