Anal & Rectal Conditions
If you have hemorrhoids, you are not alone. Far from it! More than half of adults in America suffer from hemorrhoids. But few people with hemorrhoids ask their doctors for help. This might be because they are embarrassed, because they think the only treatment is painful surgery, or because they want to try home remedies before seeking medical advice. However, it is very important to tell your doctor if you think you may have hemorrhoids. Hemorrhoids detected early can usually be resolved with non-surgical in-office treatment.
Hemorrhoids are swollen veins in the anal canal. These veins normally provide cushioning during bowel movements and may swell after repeated lifting, straining, constipation, passing hard stools, diarrhea, or pregnancy. Hemorrhoids aren't life-threatening but they can be painful, and if swelling persists the veins may become permanently stretched ("prolapsed").
Types of Hemorrhoids
There are two kinds of hemorrhoids: internal and external. The dentate line along the circular anus muscle divides the interior nerve canal, which has no nerve endings, from the anal opening and exterior areas, which do have nerve endings. Hemorrhoids that form in the anal canal are thus called internal hemorrhoids, while those outside the anal opening are called external hemorrhoids. External hemorrhoids are typically more uncomfortable at first because there are nerves present in the area where they form. However, internal hemorrhoids often swell beyond the dentate line, causing pain and other problems.
Symptoms of Hemorrhoids
Hemorrhoid symptoms vary in type and severity depending on such factors as a person's age, anatomy and heredity and duration of the problem. The most common symptoms are bleeding, itching, burning, discomfort during bowel movements, and the feeling of fullness or of a mass in or on the anus
Pruritus, or itching, is a tingling, irritating sensation on the surface of the skin that provokes scratching. While incidental itching may be resolved by scratching, persistent itching is often only worsened by this response. Itching may be confined to one area on the body or may be an encompassing condition. When confined to a specific area, itching is usually the result of a localized contact with an irritant. When it involves the whole body, it is more likely the result of a systemic disorder and may necessitate medical diagnosis through blood tests or skin biopsy. Severe itching is experienced as akin to pain.
Causes of Pruritus
There are a great many causes of itching which include:
- Allergic reactions to food or medications
- Dry skin
- Skin disorders, such as eczema or psoriasis
- Contact dermatitis
- Insect bites or stings
- Irritating chemicals
- Parasites, such as lice
- Pregnancy, in some women
- Rashes from diseases like measles or chicken pox
- Certain systemic disorders like diabetes or leukemia or kidney failure
Treatment of Pruritus
Patients experiencing itching are advised to avoid scratching, since this simply exacerbates the problem, and to wear loose, non-irritating fabrics against the skin. Simple itching may be helped by moisturizing creams, oral antihistamines and topical corticosteroids. Cold compresses and lukewarm baths, particularly with a colloidal oatmeal solution, may also be helpful. Where itching is severe or persistent, it is important to seek medical assistance in determining the underlying cause of the problem.
Complications of Itching
When itching is followed by scratching that breaks the skin, there is danger of infection. When such skin breaks become hot, red or swollen, or when they are accompanied by fever or swollen glands, a physician should be consulted since antibiotic treatment is usually required. Similarly, when red lines emanating from the site appear, this indicates an involvement of the lymphatic system and should not be ignored. Severe or persistent itching requires medical consultation since it may be a symptom of a more serious underlying medical disorder. When allergic itching is combined with any breathing or swallowing difficulty, it constitutes a medical emergency.
An anal fissure is a tear in the tissue that lines the anus or the anal canal. This condition often leads to pain, burning and bleeding during bowel movements, as well as itching and a visible crack in the skin around the anus. While an anal fissure can usually heal on its own with little or no complications, it is important to seek medical attention for an anal fissure in order to obtain relief of symptoms and a healthy return to regular bowel movements.
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 special treatment provided by their doctor. 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.
A fistula is an abnormal passageway or opening between two organs or areas within the body. Fistulas can develop in various parts of the body and are usually cased by tissue damage that has worn over time, ultimately creating an opening, or a fistula.
Rectoceles are a type Â of hernia Â that occurs when part of the rectal or bladder wall bulges into the vagina. A rectocele is known as posterior prolapse. This Â condition may be a result of multiple or difficult childbirths, chronic cough, chronic constipation or weakened vaginal muscles. They are more common in women who have already been through menopause. Obesity and smoking also increase a woman's risk of developing this condition.
Rectoceles Â may cause pain or pressure in the vagina or rectum, pain during sex and bladder problems. Your doctor may perform a medical examination and take X-rays in order to diagnose these conditions. Treatment depends on the severity of the condition. Talk to your doctor to determine if you have this condition and to decide which method of treatment is best for you.
Rectal prolapse is a condition where a section of the wall of the rectum falls or descends from its normal position and in some cases, may protrude out of the anus. This condition occurs most commonly in children under the age of six and the elderly. Prolapse is a common condition in which one or more organs move from its normal position and may protrude out of the body or cause pain or pressure within the affected area. Women are most often affected by prolapse after childbirth, and may experience rectal and vaginal prolapse at the same time.
Nonrelaxing Puborectalis and Abnormal Perineal Descent
Nonrelaxing puborectalis and abnormal perineal descent are two conditions related to constipation. Both conditions involve abnormal functionality within the pelvic floor area.
Nonrelaxing puborectalis, also known as paradoxical puborectalis contraction, refers to an abnormal relaxation of the pelvic floor muscles when the patient attempts to defecate. This condition, which affects both men and women, can occur in children as well as adults. Symptoms include straining to initiate or complete defecation and experiencing an incomplete evacuation of the stool.
There are various clinical options for diagnosing and treating this issue and its symptoms. Testing may include the use of electromyography (EMG) and defecography to document paradoxical puborectalis contraction. Treatment methods typically consist of the use of biofeedback, injections of botulinum toxin or several types of surgical approaches.
Abnormal Perineal Descent
Abnormal perineal descent is also associated with difficulty defecating. Abnormal perineal descent occurs when the skin and tissue located between the vaginal opening and rectal opening, also known as the perineum, descends below its normal position. This prolapse can be caused by a tearing or stretching of the ligaments that support the area, and is often accompanied by pelvic organ prolapse.
Abnormal perineal descent can be diagnosed through testing, which may include a defecography X-ray. This type of imaging can identify the position of the pelvic organs and monitor whether they descend significantly during defecation.
Physical therapy may be successful in alleviating the symptoms of perineal descent, although surgery is often required to repair the weakened or torn ligaments that support the perineum.
Incontinence is a common condition that involves the involuntary loss of urine. Although it is not usually a serious condition, incontinence can be embarrassing and affect a person's daily life. Incontinence is most common in women, especially during and after pregnancy, but can affect people of all ages.
Constipation affects most people at some point in time. A person is considered to be constipated if they have three or fewer bowel movements in a week or if they do have a bowel movement they are hard, dry or painful. Depending on how often a bowel movement normally occurs will determine what is considered to be "infrequent" for each individual patient, but constipation is usually defined as fewer than three movements a week.