Anorectal Surgery
Anorectal surgery encompasses a variety of procedures aimed at treating conditions affecting the rectum and anus. At Heritage Surgical Group, our expert surgeons provide comprehensive care for a range of anorectal disorders, ensuring patients receive the highest quality treatment to improve their health and quality of life.
Anorectal surgery involves treating various conditions such as hemorrhoids, fissures, abscesses, fistulas, and rectal prolapse. Heritage Surgical Group offers advanced surgical techniques and personalized care to address these issues effectively.
Conditions Treated
Treatment of anal fistula
This condition is chronic, which means that patients can have problems for years, before opting for surgery, which is the only way to solve the problem.
- Description and Types:
- Normal vascular structures in the anal canal that can become symptomatic.
- Internal (Inside the Anal Canal) or External (Outside of the Anal Canal covered with skin).
- Symptoms:
- Bleeding, itching, protrusion through the anal canal, and thrombosis.
- Treatment:
- Non-Surgical: Sitz baths, stool softeners, and fiber supplements.
- Rubber Band Ligation: In-office procedure for internal hemorrhoids.
- Surgical Interventions: Transanal Hemorrhoidal Dearterialization (THD) or hemorrhoidectomy for persistent symptoms.
- Description and Symptoms:
- Result from trauma to the anal canal from hard stools, or from a very strong anal sphincter.
- Causes severe pain and anal spasms.
- Treatment:
- Medical Management: Topical medications, sitz baths, and fiber intake.
- Surgical Intervention: Sphincterotomy for fissures refractory to medical management.
Peri-Anal/Peri-Rectal Abscess
- Description and Symptoms:
- Characterized by swelling and pain near the anus.
- Results from an obstructed anal gland causing pus collection in the subcutaneous tissue.
- Treatment:
- Incision and Drainage: Performed in an outpatient setting with local anesthesia.
- Antibiotics: Prescribed if cellulitis is present.
- Cultures: Obtained to identify bacteria and tailor antibiotic therapy.
Anal Fistula
- Description and Symptoms:
- Chronic condition often associated with peri-rectal abscess.
- Represents a tract formed due to infection, leading to recurrent abscesses if untreated.
- Treatment:
- Elective Surgery: Surgical disruption of the tract after the acute infection or abscess has healed to prevent recurrence.
Rectal Prolapse
- Description and Symptoms:
- Common in older women, particularly multiparous ones.
- Occurs due to weakening of the pelvic floor muscles and presents as a “mass” that protrudes through the anus during defecation.
- Treatment:
- Non-Surgical Management: Increased fiber and water intake, pelvic floor exercises.
- Surgical Management: Abdominal or perineal approaches to prevent telescoping and improve quality of life.
Hemorrhoids
Anal Fissure
Disruption or trauma to the anoderm with passage of hard stools can lead to severe pain and anal spasms. Treatment includes prevention of anal spasms with topical medications to promote healing of the fissure. Supportive treatment with sitz baths and fiber assist in the healing.
Anal fissures refractory to medical management may require surgical intervention with sphincterotomy (partial cutting of the sphincter muscle) to reduce the pressure and tone of the anal sphincter and promote healing. Although the risk is low, this procedure may increase the chances of fecal incontinence.
Rectal Prolapse
Typically seen in older women, particularly those who are multiparous, prolapse of the rectum occurs secondary to weakening of the pelvic floor muscles in combination with chronic straining, diarrhea, and/or constipation. It can present as a “mass” that protrudes through the anus with defecation and reduces spontaneously or requires reduction manually. The “mass” that is described is the rectum which telescopes on itself.
Diagnosis is made on physical exam, on the observation of rectal protrusion with straining (or Valsalva maneuver), or defecography. It can lead to incontinence of both stool and urine, pain, bleeding, and diminished quality of life.
Initial management focuses on patients’ symptoms and includes increased fiber and water intake to reduce chronic straining, diarrhea, and/or constipation. Pelvic floor exercises may help strengthen muscles that are involved in prolapse.
Surgical treatment may be required for patients who fail medical management or whose risk of incarceration (or rectum that can’t be reduced) is high. Surgical intervention can be performed via the abdomen or perineum. Both techniques aim to shorten the amount of redundant colon to prevent telescoping.
When the cause is unknown, the person may be helped with anti-inflammatory drugs.
Proctitis
Proctitis is an inflammation of the lining of the rectum.
The disease can affect 2,510 cm of the lower part of the rectum. Some cases respond immediately to treatment, while others are persistent or recurrent and require prolonged treatment. Some cases eventually progress to ulcerative colitis.
There are several reasons that a patient may develop Proctitis. It can result from Crohn’s disease or ulcerative colitis. It can also occur due to sexually transmitted diseases (such as gonorrhea, syphilis, infection with Chlamydia trachomatis, herpes simplex virus or cytomegalovirus).
Proctitis may be caused by specific bacteria such as salmonella or the use of antibiotics that destroy normal intestinal bacteria and allow other bacteria to grow in their place. Another cause of proctitis is radiotherapy of the rectum or its surrounding area.
Treatment of proctitis
Antibiotics are best used to treat proctitis caused by a specific bacterial infection. When proctitis is caused by an antibiotic that damages normal intestinal bacteria, harmful bacteria that have replaced normal ones should be destroyed with metronidazole or vancomycin.
When the cause is unknown, the person may be helped with anti-inflammatory drugs.
Hemorrhoids
Hemorrhoids are swollen tissue that contains veins and is located in the wall of the rectum and anus.
Hemorrhoids can be inflamed, they can form a blood clot (thrombus) or they can become enlarged and bulge. Hemorrhoids that remain in the anus are called internal hemorrhoids, and those that protrude outside the anus are called external hemorrhoids.
They can occur due to constant stress during bowel movements (defecation), and constipation which increases the stress even more. Hemorrhoids are sometimes caused by liver disease, which increases the blood pressure in the portal vein.
A doctor can easily diagnose inflamed, painful hemorrhoids by observing the anus and rectum. Anoscopy and sigmoidoscopy help the doctor assess if the patient has a more serious illness such as a tumor.
Treatment of Hemorrhoids
Usually, as long as they do not cause symptoms, hemorrhoids should not be treated. Taking substances that relieve constipation can be of huge help. Bleeding hemorrhoids can be treated by injection sclerotherapy, which is injecting a substance that causes the veins to become clogged with scar tissue.
Large internal hemorrhoids and those that do not respond to injectable sclerotherapy are tied with rubber bands. A procedure called rubber band ligation leads to painless reduction and deterioration of hemorrhoids.
Hemorrhoids can also be removed by laser or infrared radiation.
If none of these treatments work, then surgery is an option too.
Wound care instructions and pain medication will be provided by your surgeon
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Treatment of anal abscess
The goal of the treatment is to eliminate the accumulated pus content as soon as possible. As this is the only effective way at this stage of the disease.
An incision is made in the skin above the swollen area and the contents are eliminated. Immediately after this intervention, the patient feels significantly relieved, the pain and the fever are gone.