Anal and Perianal Diseases

Anal Fissure

Anal fissure is a tear in the anus resulting from constipation or diarrhea. It may also be observed in infectious bowel disease cases. However, difficulty in defecation and therefore straining is the most common cause. The area where the tear occurs causes a great deal of pain due to its sensitive structure which is related to the intense presence of pain nerves. Intense pain occurs as if the area is being torn or cut. Sometimes bleeding may be seen besides the pain and the pain may continue for several hours after defecation. Patients might procrastinate defecating due to the painfulness of the process and this results in constipation and causes the fissure to get progressively worse.

Constipation

The first thing to do as a treatment is to prevent constipation by applying a proper diet. In acute cases the fissure regresses after prevention of constipation and applying warm sitting baths. However, if the situation becomes chronical, then the proper treatment is surgery.

Anal Fistula

Anal fistula is an opening in the shape of a tunnel which occurs between the ending of large intestine and the skin surrounding the anus and it cannot close by itself. It usually occurs after an infection and abscess in the anal area. Continued infection after the abscess is drained and recurrent abscesses result in the occurrence of fistula. Approximately half of the patients suffer from anal fistula after occurrence of an abscess around this area.

Anal Fistula

Symptoms of anal fistula are;

  • Irritation in the skin around the anus
  • Pain while sitting and moving and during defecation
  • Smelly drainage around the anus
  • Observation of blood or pus during defecation

The outer end of the fistula could be seen as a little hole on the skin near the anus. The path between the outer and the inner hole of the fistula can vary. Therefore, illuminating this path is very important in terms of treatment. In order to achieve this, taking an X-ray after injection of some radiologically detectable drugs inside the fistula or having advanced radiological examinations may be necessary. The treatment of fistula is surgery and there are various treatment methods depending on the path of the fistula. Since the possibility of recurrence is high, performing the first surgical procedure appropriately is the most important factor that prevents repetition.

Hemorrhoids

Hemorrhoid is a disease characterized by swollen blood vessels around the anus or where the rectum, which is the last part of the large intestine ends. It is called external hemorrhoid if it is localized outside the anus on the skin and called internal hemorrhoid if it is inside the anus. Chronical constipation, straining during defecation, and pregnancy are the main reasons. While symptoms of external hemorrhoid are mainly pain and itching, bleeding is the most common symptom for internal hemorrhoid. Although external hemorrhoid can be repaired by itself in a few days, sometimes due to the clotting of the blood in the hemorrhoid it may turn into a painful lump and removal of the blood clot by a minor procedure might be needed. Bleeding is the most common symptom for internal hemorrhoid. Blood dropping after defecation and observation of a blood drop on the toilet paper is typical.

Internal and external hemorrhoids

Internal hemorrhoids have 4 degrees:

  1. Degree: Hemorrhoid is not pulpable, bleeding occurs.
  2. Degree: Hemorrhoid comes out of the anus during defecation and goes in by itself.
  3. Degree: Hemorrhoid comes out of the anus during defecation and it needs to be pushed inside by using hands.
  4. Degree: Hemorrhoid is outside of the anus, cannot be pushed inside, and is very painful.

Before starting the treatment an examination and rectoscopy is needed. It should be proven that the bleeding is due to the hemorrhoid since sometimes bleeding might also be a symptom of rectum tumors.

The first precaution is the prevention of constipation and applying a diet containing fibrous nutritions. While medical treatment is appropriate for 1st and 2nd degree hemorrhoids, surgical treatment is required for 3rd and 4th degree hemorrhoids.

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