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Anorectal conditions

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Piles or Hemorrhoids are columns of blood vessels which are present in the anal canal and Rectum. They get engorged or dilated with long standing constipation or straining at stools. Sometimes they may form as a result of liver diseases or may signal problems elsewhere in the large intestine.

They commonly present with painless bleeding while passing stools. The bleeding is usually bright red and comes as a jet or splash. In advanced cases, these may protrude out from the anus may cause heaviness or pain.

Piles can cause bleeding which can cause weakness and deficiency of blood in the body. They can also cause pain and discomfort in advanced stages.

Piles can be a symptom of underlying rectal cancer which is causing blockage of the blood vessels of the anal canal. This is quite rare but if suspected , should be evaluated thoroughly before undertaking surgery for piles.

The treatment of piles may be through medicines or surgery. Medicines are used initially and for mild cases. More severe cases of piles may require interventions or surgery.

Certain non surgical interventions for piles are there which include

  1. Rubber band ligation – In this , a small rubber band is applied onto the base of the piles mass using a special applicator known as banding gun. This squeezes the blood vessels in the Hemorrhoids causing it to shed off.
  2. Injection Sclerotherapy/ This involves injection of a chemical agent into the piles which causes the blood vessels to shrink and piles mass to disappear in a few days

Surgery for piles can be categorised as

  1. Conventional or open surgery- This is done using the conventional surgical instruments like scissors and cautery and the piles masses are cut off leaving a wound which heals in a few days.
  2. Stapler Hemorrhoidectomy- This is indicated for advanced cases with protrusion of mass outside the anus. This removes a full disc of anorectal tissue including the piles mass and leaves a row of staples inside the anal canal without any external wound. This process is painless and with a faster recovery.
  3. Laser Hemorrhoidectomy- This can be done for all grades of piles and uses laser fibre for cutting the Hemorrhoids. It is superior to conventional treatment with lesser pain and faster recovery.

If the surgery for piles is done in a technically sound manner by an expert, the problem should not recur. However, a technical problem during the surgery or failure of lifestyle modification leading to chronic constipation can cause the problem to recur after a few years.

Fissure in ano

Fissure refers to a small vertical crack or ulcer in the anal canal which may extend outside.

The main symptoms of fissure is pain which can be excruciating especially while passing stools. There may be bleeding along with stools which is usually not severe.

Long standing constipation and straining at stools causes a tear in the lining of the anal canal which is how a fissure is formed. When the fissure is there for a long time, a skin tag may appear which can cause discomfort and itching

The treatment of fissure in early cases is through medicines including various tubes and stool softeners. In more severe cases, surgery is required in which part of the muscle of anal canal is cut to help relieve the pain and facilitate healing of the fissure.

Perianal Fistula

A fistula is a abnormal connection between part of the stool passage and the outside skin. It usually forms as a result of infection in the Perianal area which leads to formation of this abnormal connection.

The different types of fistula can be high or low, internal or external depending upon their location. The treatment of these fistulae will depend upon the type of fistula.

The main symptom of perianal fistula is pus or watery discharge from an opening near the anal area. This may cause discomfort and itching. Sometimes, there may be multiple openings leading to soiling of the undergarments.

The treatment of fistula is usually through surgery. Medicines may help relieve the infection partially but cure is only possible by complete removal of the fistula tract.

  1. Conventional surgery- This is done using the traditional instruments and involves laying open or removal of fistula tract. A wound is formed as a result which heals within a few days.
  2. Endoscopic surgery- Selected cases of fistula may be treated endoscopically by using a special telescope. This process is known as VAAFT or video assisted fistula treatment.
  3. Seton placement- This involves insertion of a thread or suture into the tract and then tying it externally. This thread is gradually tightened so that it cuts the tract and brings ot towards the skin surface. This is indicated only in cases where surgery is not possible or may result in damage to sphincter muscles.
  4. Laser surgery- This is latest treatment for fistula in which the tract is burnt from inside using a laser fibre which leads to gradual closure of the tract. This leads to less pain and faster recovery.

Pilonidal sinus

Pilonidal sinus is a small opening in the skin of the gluteal or natal cleft which has a tuft of hair buried within. These hairs give rise to infection which presents as pain, swelling and sometimes pus discharge from the opening.

Pilonidal sinus is diagnosed by clinical examination especially when the opening reveals a tuft of hair buried beneath the skin.

Early cases of Pilonidal sinus require cleaning the opening, antibiotics and dressing of the wound. In advanced cases and when conservative treatment fails, surgical excision of the Pilonidal sinus may be required.

Surgery for Pilonidal sinus requires complete removal of the sinus along with the tract to prevent recurrence. The wound may be left open to heal or may require surgical closure with the help of skin flaps.

The laser fibre may be used for treatment of sinus in select cases. The laser energy burns the sinus tract from within facilitating closure of the tract.