Anal Fissures

A small tear in the thin mucosa that lines the anus is known as an Anal Fissure. The reason for anal fissure is many, though it may occur when you pass hard or large stool during a bowel movement.

What are the Symptoms and Treatment?

Anal fissures create discomfort, pain and bleeding during or post bowel movement. Patients may also experience spasms in the ring of muscle at the end of the anal sphincter. Anal fissures are commonly identified in young infants, but it can affect both men or women of any age group. It can be cured with simple treatments, such as consumption in High-Fiber Diet and sitz baths. People may go under anal fissure medication or surgery based on evaluation through visual inspection of the Anas and anal canal.

Pilonidal Cyst

Following the onset of puberty, sex hormones affect the pilosebaceous glands, and subsequently, hair follicles can become plugged up with keratin. Folliculitis can result producing edema and follicle occlusion. If the infected follicle extends and ruptures into the subcutaneous tissue, a pilonidal abscess forms. This results in a sinus tract leading to a deep, subcutaneous cavity.

Loose hairs become entrapped within the sinus by friction and movement of the patient's buttocks (when sitting or standing), inciting a foreign body reaction and infection. The incidence of pilonidal disease is 2-4 times more likely in men than in women. Hair characteristics such as kinking, coarseness, and growth rate have been studied in their relation to incidence. Other factors including increased sweating, poor personal hygiene, and obesity have been linked to an increased risk.

Additionally, the disease is more common in younger age groups, and is rare is persons over 40. Pain and purulent discharge are present in the majority of cases and are the most frequently described symptoms.The diagnosis is made by inspection of the area and identification of the epithelialized, follicle opening. A deep area of induration can most often be palpated.

What is the Treatment?

Antibiotics may not be helpful for the treatment of Pilonidal disease. A preferred treatment method is an incision to the cyst through surgery in the ambulatory settings. In Surgery, a Pilonidal abscess is examined and treated as any as such type of abscess. The primary method of the treatment of an abscess is Incision, drainage, curettage.

An effective Personal Hygiene should be followed and proper shaving is a must in the affected area. Eventually, it will help prevent contamination of the healing wound. Most wounds heal within 4 weeks, but a meticulous cleansing process should be followed for at least 3 months to complete the healing journey.

For patients with pilonidal disease which persists despite minimal surgery, the surgical options for management include excision with primary closure, excision and laying open of the tract to heal by secondary intention, wide and deep excision to the sacrum, and incision with marsupialization. Each has their own advantages and disadvantages and should be tailored to the patient.

Perianal Abscess

A perianal abscess is a collection of pus near the anus. Blocked perianal glands, infection of an anal fissure, or sexually transmitted infections, and are all thought to be inciting factors. The abscess usually begins when bacteria enters through a tear in the lining of the rectum or anus.

Most often, this occurs between the internal and external sphincters (intersphincteric abscess), where the perianal glands are located. As the abscess increases in size, most will follow the plane of least resistance and spread towards the surface, creating a perianal abscess. Occasionally, the infection can spread into the ischiorectal fossa or above the level of the levator muscles, creating ischiorectal and/or supralevator abscesses, respectively.

Although supralevator abscesses are difficult to diagnose, perianal and ischiorectal abscesses still seem to account for the majority of the ones encountered.

In terms of risk, those individuals with diabetes, immunocompromised states, those with inflammatory bowel disease, or who engage in receptive anal sex, appear to be at higher risk for developing an abscess, than those without these risk factors. Pain and swelling in the perianal area is the most common presenting complaint of perianal abscesses. Discharge of pus may be apparent, but is not necessary for diagnosis.

The cardinal signs of infection (pain, fever, redness, swelling, and loss of function) are typically present, as would be in most types of abscess or infectious processes. A good rectal exam may confirm the presence of an anorectal abscess, and/or proctosigmoidoscopy can be used to exclude other or associated diseases. In addition, a good history is always warranted, as deep rectal abscesses may be caused by intestinal disorders such as diverticulitis or Crohn's disease.

What is the Treatment?

As for virtually any abscess, the primary treatment is prompt incision and drainage of the abscess. Depending on its location, the procedure may take place in an outpatient setting. Deeper abscesses may require surgery with appropriate anesthesia. The expectations following treatment is very good, particularly with prompt treatment. Complications include anal fistula formation, recurrence, scarring and systemic infection in severe cases.

Anal Fistula

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract (anus).

Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland.

What is the Treatment?

Surgery to treat anal fistula may need several steps, starting the a drainage procedure and if the fistula persists, it may require total removal of the fistula tract, called a Fistulectomy.

Hemorrhoids

Hemorrhoids are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids have a number of causes, although often the cause is unknown. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids).

Hemorrhoids are very common. Nearly three out of four adults will have hemorrhoids from time to time. Sometimes they don't cause symptoms but at other times they cause itching, discomfort and bleeding. Occasionally, a clot may form in a hemorrhoid. These can be extremely painful and sometimes need to be lanced and drained.

What is the Treatment?

Several effective options are available to treat hemorrhoids. Many people can get relief from symptoms with home treatments and lifestyle changes.

What are the Symptoms?

  • Painless bleeding during bowel movements
  • You might notice small amounts of bright red blood on your toilet tissue or in the toilet
  • Itching or irritation in your anal region
  • Pain or discomfort
  • Swelling around your anus
  • A lump near your anus, which may be sensitive or painful

What are the Complications from Hemorrhoids?

Rarely, chronic blood loss from hemorrhoids may cause anemia. If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," another cause of extreme pain, and could ensue a severe infection.

Anal Pain

Oftentimes, the cause of anal pain is not clear or readily evident. This mandates a thorough exam under anesthesia which may also include proctosigmoidoscopy.