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Benign Anorectal Conditions
Many people suffer from common conditions that affect the anal area, such as hemorrhoids, fistulas, fissures and warts. Distinguishing these conditions from each other is important because treatment will vary and an incorrect plan of action will prolong suffering and delay cure. Unfortunately, many patients and treating physicians attribute symptoms of pain, bleeding, itching or lumps to hemorrhoids when in fact another condition may be present. Consultation with a colorectal surgeon is important to arrive at the correct diagnosis and begin the proper treatment.
Hemorrhoids may be internal or external or a patient may have both. Internal hemorrhoids cause bleeding and/or protrude through the anus, but they rarely cause pain. External hemorrhoids may cause anal pain or irritation and may interfere with cleanliness. Small internal hemorrhoids may easily be treated with a technique called rubber-band ligation or medication injections that cause shrinkage. Larger internal hemorrhoids usually require surgery, especially if they begin to protrude. Luckily, surgical options are available. With one technique, the surgeon uses an ultrasound to guide placement of a stitch. This helps the surgeon reduce blood flow to the hemorrhoid while lifting the hemorrhoidal tissue to reduce the protrusion. External hemorrhoids may require surgical removal if the symptoms warrant.
Abscesses around the anus can cause a persistent pain, which can be quite severe. This is a form of infection, similar to a boil, that occurs within the anal mucus glands. If the abscess bursts on its own, there will be a release of pus and a decrease in pain. Unfortunately, some patients will be left with a fistula, or tunnel, that connects the inside of the anus to the skin outside. A fistula can cause recurrent abscesses or persistent pus drainage. Once a fistula is present, they generally will not go away on their own and surgery is necessary. The main goals of surgery are to close the fistula and preserve normal function of the anal sphincter muscles. Sphincter muscles help us control stool so that incontinence, the involuntary loss of stool, does not occur. Our colon and rectal surgeons are highly skilled in treating fistulas while protecting the sphincter muscles, minimizing the risk of incontinence.
An anal fissure is a small tear or cut in the lining of the anus and causes severe pain or burning with bowel movements. The pain almost always happens during defecation and may last for hours after the bowel movement. Initial treatment will focus on stool softening and constipation relief, if present. Medications can be used to promote healing, but this approach is not always successful. Occasionally, Botox is used, but again, with mixed results. A persistent fissure may require an operation, usually performed on an outpatient basis. The patient often returns to work in a couple of days. Success is very high with this surgery.
Warts are caused by a virus known as the Human Papillomavirus. (This is different from the Human Immunodeficiency Virus, or HIV.) It is considered a form of a sexually transmissible disease and affects both women and men. The virus may lie dormant for years; the presence of a wart does not necessarily mean that the patient was exposed recently.
Pilonidal cysts and abscesses typically occur in the middle lower back just above the buttocks. It is thought to occur because of infection in the hair follicles of the skin and is mostly found in teenagers and young adults. Acute infections can be treated with antibiotics, but many patients will go on to have repetitive infections that interfere with school, work and sports. If this occurs, surgery is generally needed to eliminate the problem.
The rectum can fall out, or prolapse, through the anus for several inches. In women, this may occur as part of a generalized pelvic-floor problem in which the vagina, uterus or bladder may prolapse as well. Treatment is tailored to the individual patient, but generally surgery is required to eliminate the problem. Rectal prolapse may be repaired with either an abdominal or rectal approach. The abdominal surgery is easier to recover from, but the prolapse is more likely to occur again. The rectal approach usually has better long-term results and can be performed with laparoscopy.
For all of these conditions, a consultation with a colorectal surgeon will help you understand which option is better for you.