Ano-Rectal Procedures And Operations
Treatment for Hemorrhoids
Hemorrhoids should only be treated if they are painful or cause complications. To choose an appropriate treatment, the cause or causes need to be determined. Making changes to diet and fluid intake, toilet habits and exercise can relieve symptoms and prevent recurrence of the problem. Relief can also be found by treating related problems that irritate the hemorrhoid and affected areas (such as diarrhea and constipation).
Beyond this, treatment depends on the type and severity of the hemorrhoid as well as how it has responded to any previous treatment. Hemorrhoids are divided into four grades or stages depending on their history. Grade I and II hemorrhoids are usually treated non-surgically, while Grades III and IV are more likely to require surgical correction.
Rubber Band Ligation (RBL)
An elastic band is wrapped around the hemorrhoid, cutting off blood supply and causing the tissue to die and drop off. External hemorrhoid and early-stage internal hemorrhoids can be treated with RBL.
Infrared Photocoagulation (IPC) or Electrocoagulation
The hemorrhoid is exposed to a warm, painless infrared light or electrical current over a series of treatment sessions.
A sclerosing solution injected into the blood vessels causes the hemorrhoids to shrink.
Surgery is usually reserved for very advanced cases with a large amount of protrusion. The hemorrhoid is removed with a scalpel, cautery device or laser. Local or general anesthesia may be used and hospitalization is usually required, with recovery taking up to two weeks.
This recently introduced procedure involves the insertion of a circular stapler into the rectum that pushes internal and external hemorrhoids and surrounding tissue up into the anal canal and staples them in place, cutting off blood supply.
Treatment of an Anal Fissure
While many anal fissures can heal on their own with no treatment needed, patients with troublesome symptoms that do not respond to a fiber-rich diet, increased water intake, stool softeners and regular exercise may require a specialized treatment plan. Depending on the severity of the condition, a medicated cream, suppository or BOTOXÂ® injection may be recommended to reduce inflammation in the affected area.
For anal fissures that are chronic and not responsive to treatment, surgery may be performed. Surgery will involve severing a part of the sphincter muscle to reduce the spasms that are causing pain. The fissure and any scar tissue that has developed may be removed in order to restore the muscle back to its original condition. This procedure is performed on an outpatient basis and is considered safe and highly effective in most cases.
Treatment of an Anal Fistula
An anal fistula is an abnormal connection between the anal canal and another part of the body. A patient with an anal fistula will pass feces through the fistula instead of the anus. Fistulas most commonly form after trauma, surgery, infection or inflammation. Specifically, anal fistulas may result from prolonged diarrhea or constipation or from certain conditions such as Crohn's disease, injury during childbirth, malignant tumors, leukemia and tuberculosis.
A fibrin injection is a non-surgical option for treatment. Fibrin glue, which is a combination of the clotting agents fibrinogen and thrombin, is injected into the external opening of the fistula to create a seal without affecting the function of the sphincter muscle. Injections may be the sole treatment or may be performed after another procedure to increase chances of success. Fibrin injections are particularly beneficial for patients with recurrent fistulas.
Fistulotomy is a surgical procedure designed to repair an anal fistula. A fistula is an abnormal tunnel that can develop near the anal glands. Anal fistulas usually form due to an infection, but may also appear following surgery or traumatic injury. They are defined by painful bowel movements, bleeding, and skin irritation around the anus. A digital rectal exam will be performed to diagnose the anal fistula.
Fistulotomy is often the most effective treatment for this condition, since few anal fistulas will heal on their own. The aim of the procedure is to close the fistula while protecting the sphincter muscles, which enable the anus to open and close. Fistulotomy is performed under anesthesia, and involves cutting open the entire length of the fistula, flushing out its contents and flattening the tunnel. Patients may need antibiotics to prevent infection and pain medication to alleviate discomfort following surgery. The anal fistula will eventually heal into a flat scar.
Ligation of the Intersphincteric Fistula Tract, or LIFT, is a relatively new surgical technique used to treat complex anal fistulas and prevent them from recurring. Complex anal fistulas are abnormal tracts that develop between the anal canal and tissue near the anus, and may be associated with chronic diarrhea or inflammatory bowel syndrome.
Using the LIFT technique, the surgeon is able to access the deep fistula and drain it without damaging the sphincter muscles that enable the anus to contract. This procedure is only performed in patients over the age of 18. The LIFT technique involves cutting the internal opening of the anal fistula and clearing the area of infected tissues. A segment of the fistula is removed and nearby portions are stitched closed to promote its healing.
Mucosal Advancement Flap
A mucosal advancement flap, or MAF, operation is performed to treat anal fistulas. Anal fistulas are tracts that form in the anal cavity, often due to infection. MAF is considered among the most effective treatment methods for complex anal fistulas. Common symptoms of an anal fistula include pelvic pain, swelling and difficulty passing bowel movements. Typically diagnosed after a digital rectal examination, this condition almost always requires surgery.
MAF operations are performed with the patient under general anesthesia. The surgeon identifies the internal opening of the anal fistula and cuts open a flap of the surrounding mucosal tissue. The flap will expose the fistula, which is then drained and inflamed tissue is removed. The fistula is sutured shut, using the flap of mucosal tissue as a covering for the area. Discomfort following the surgery is usually well managed with pain medication.
An anoplasty is a reconstructive surgical procedure performed to treat anal stenosis. Anal stenosis, also known as anal stricture, is a rare, debilitating condition that occurs as a result of a narrowing at the bottom of the anal canal. Anal stenosis is found in both very young children and adults.
Anal stenosis can be caused by a variety of factors, including venereal disease, excessive or improper use of laxatives and inflammatory bowel diseases such as Crohnâ€™s disease or ulcerative colitis. Genetics can also play a role in the condition. Most cases of anal stenosis, however, are caused by a prior anorectal procedure, such as hemorrhoid removal surgery. The symptoms of anal stenosis may include difficult or painful bowel movements and rectal bleeding.
When anal stenosis is suspected, the doctor will perform a visual exam of the anal canal to make a positive diagnosis. Another testing method that may be employed is a digital rectal examination, which will help determine the presence and extent of the stenosis.
Mild cases of anal stenosis can be treated with nonsurgical methods, such as fiber supplements or stool softeners. For more severe cases, an anoplasty is usually necessary.
Performed under general anesthesia, anoplasty involves stretching the anal canal so that stools can be passed comfortably. Most patients will be able to return home the same day as the procedure. The stitches in the anal canal will dissolve on their own, with the wound is generally completely healed in several weeks. Some patients may experience a small amount of bleeding in the days after the anoplasty, and any complications following the surgery are typically mild.