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Benign anorectal diseases: hermorrhoids, anal fissure, anal fistula, perianal abscess

Cybil Corning, MD
FACS, FASCRS
Peter Kuan-Teh Lee
MD, FACS
Stefanie Schluender, MD
FACS, FASCRS
Jennifer Ford
FNP-BC, RNFA
Sarah Plummer
FNP-C, CRNFA

Practice Highlights


Robotic colorectal surgery since 2014

WELL-ESTABLISHED ENHANCED RECOVERY AFTER SURGERY (ERAS) PROGRAM

High-resolution anoscopy

Multidisciplinary GI tumor board

Sphincter-sparing surgery for rectal carcinoma

Sacral nerve stimulation for fecal incontinence

Anal manometry

What is anorectal disease?

Common non-cancerous anorectal diseases include hemorrhoids, anal fissure, anal fistula and perianal abscess. These diseases can cause discomfort, pain, and significantly impair quality of life. Sometimes these conditions can be managed without surgery, however in more severe cases surgery may be required.

  • Hemorrhoids, also called piles, are damaged veins similar to varicose veins in the anus and lower rectum. External hemorrhoids occur outside the body in the skin of the anus and may cause pain, burning and itching. Internal hemorrhoids cannot usually be felt, but may cause bleeding during bowel movements. Sometimes an internal hemorrhoid will protrude through the anal opening and cause pain and irritation.
  • Anal fissure. An anal fissure is a tear in the thin, moist tissue that lines the anus. Anal fissures can cause pain and spasm of the anal sphincter muscle.
  • Anal fistula. An anal fistula is an infected tunnel that develops in the anal area, usually as a result of an abscess.
  • Perianal abscess. A perianal abscess is an infection in the skin near the anus that appears as a tender, red pus-filled lump.

Who gets anorectal disease?

Risk factors for hemorrhoids include:

  • Straining during bowel movement
  • Obesity
  • Pregnancy
  • Low fiber diet
  • Chronic diarrhea or constipation
  • Heavy weight lifting
  • Having anal intercourse

Anal fissures are very common and often resolve on their own. More problematic cases of anal fissures can be due to constipation, complications from Crohn’s disease or ulcerative colitis, trauma to the anal canal, STDs and HIV, or cancer.

Anal fistulas usually happen as a result of an anal abscess, but can also occur in people with Crohn’s disease, after trauma to the anus, or after radiation therapy for cancer.

Perianal abscesses are more common in men than in women and may happen as a result of inflammatory bowel disease.

Surgical Treatment of Anorectal Disease

Hemorrhoids

If hemorrhoids require surgery, your surgeon may perform a hemorrhoidectomy. Small cuts are made around the anus and the hemorrhoids are removed. This is typically done as an outpatient procedure. Another option is the procedure for prolapse and hemorrhoids (PPH), where your surgeon uses a stapler-like device to cut off blood supply to hemorrhoids so that they shrivel and die. During hemorrhoidal artery ligation and recto anal repair (HAL-RAR), Doppler technology is used to identify the arteries supplying blood to the hemorrhoids. Your surgeon then ties them off.

Anal fissures

For chronic anal fissures, your sugeon may inject BOTOX into the anal sphincter to help it relax. Another option is to perform a lateral internal sphincterectomy, where your surgeon divides the anal sphincter muscle to release pressure and allow the fissure to heal.

Anal fistula

There are several options for the surgical treatment of an anal fistula, depending on the types and scope of the fistula.

  • During a fistulotomy, your surgeon opens and cleans the fistula, then flattens the channel and stitches it in place. This may need to be done in two stages.
  • An advancement rectal flap can reduce the amount of sphincter muscle that is cut by creating a flap from the rectal wall to cover the repair.
  • Seton placement involves using silk or latex string to help drain the infection.
  • Sometimes the fistula can be closed using fibrin glue or a collagen plug.
  • For a more complex or deep fistula, the ligation of the intersphincteric fistula tract (LIFT) procedure is a two-stage treatment that allows your surgeon to drain and repair the fistula without cutting the sphincter muscles.

Perianal abscess

Your surgeon will inject a local anesthetic around the abscess, then make an incision to drain the contents. A portion of skin and fat is removed to allow drainage and help it heal. A gauze dressing is applied.

 

Colorectal Disease Specialties We Treat

Colon Carcinoma
Rectal Carcinoma
Colorectral Polyps
Familial adenomatous polyposis
Anal Carcinoma
Small Bowel Cancers
Diverticulitis
Ulcerative colitis
| Crohn’s
Rectal prolapse
Pelvic exenteration
TAMIS for Rectal lesions
Hemorrhoids
Anal fissure
anal fistula
Perianal abscess

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