Procedures
Perianal Surgery
Assessment and management of anal fissures, anal fistula and haemorrhoids (piles).
Symptoms of Perianal Disease
Symptoms of various perianal conditions can overlap, making specialist assessment important for an accurate diagnosis. Changes in bowel habits or difficulty passing stools may also warrant assessment, particularly when symptoms are persistent.
Bleeding and discharge such as bright red rectal bleeding, blood on the toilet paper, or discharge or fluid from the anus.
Pain or discomfort around the anus, particularly during or after opening your bowels or when sitting.
Lumps and irritation including swelling or sensation of fullness around the anus, as well as persistent itching, discomfort or changes in the area.
A Brief Overview
The Perianal Region
The perianal region refers to the anus and the surrounding skin and tissues. Conditions affecting this area can involve the skin, anal canal, glands or deeper tissues.
The anus is the opening at the end of the digestive tract, where stool leaves the body. It follows the rectum, which stores stool until a bowel movement.
The anus is surrounded by two important muscles called the internal and external anal sphincters. As the rectum fills, nerves signal the need to open the bowels, and the sphincter muscles coordinate their relaxation to allow stool to pass. Together, they play an important role in controlling bowel movements and maintaining continence.
Treatment for Perianal Disease
As a colorectal surgeon, Mr Stein provides assessment and treatment for a range of perianal conditions. Your treatment pathway depends on the cause of your symptoms and is tailored to your individual needs.
Depending on the condition, treatment may involve dietary and lifestyle modifications, topical ointments or surgery. Mr Stein will discuss the most appropriate pathway with you, taking into account the nature and severity of the condition, as well as your overall health and medical history.
Treatment is tailored to your individual needs, with a strong focus on addressing the underlying cause and relieving symptoms, while supporting healing, preserving bowel function and reducing the risk of recurrence.
Anal Fistula
An anal fistula is an abnormal passage that can develop when an anal abscess does not fully heal after drainage, leaving a connection between the anal canal and an opening in the skin outside the anus.
Common Symptoms
- Recurrent pain, swelling or tenderness around the anus.
- Pus, blood or foul-smelling discharge from an opening in the skin.
- Redness, irritation or discomfort around the affected area.
Conservative Treatment
- Warm salt baths to soothe irritation and encourage drainage.
- Stool softeners to prevent irritation when passing stool.
- Antibiotics where an infection is present.
Surgical Management
Seton insertion involves placing a small rubber drain through the fistula tract to keep the passage open. This allows pus and fluid to drain, helping to control infection and inflammation and promote healing.
LIFT procedure treats the fistula while preserving bowel function by avoiding the main sphincter muscles. The tract is closed and divided through a small incision in the skin, separating the fistula from the anal canal and allowing it to heal.
Fistula plug may be inserted into the tract after any pus or debris has been thoroughly removed. The plug fills the tract which allows new tissue to grow and the fistula to heal. Dissolvable stitches are used to secure the inner end of the plug to healthy tissue, keeping the plug in place while the tract heals.
Anal Fissure
An anal fissure is a small split or tear in the lining of the anus. They are often caused by passing a hard or large bowel movement, or from a period of prolonged chronic constipation.
Common Symptoms
- Sharp or severe pain, particularly during a bowel movement. The pain may linger and can sometimes radiate to the thighs or lower back.
- Itching, cramping or a burning sensation around the anus.
- Bright red bleeding, usually seen on the toilet paper or in the stool.
- A feeling of tightness or spasm around the anus, or a small lump near the opening.
Conservative Treatment
Many anal fissures heal with good dietary and lifestyle measures, particularly by keeping bowel movements soft and easy to pass.
- A high-fibre diet and adequate water intake can help prevent constipation and reduce straining.
- Stool softeners assist with passing bowel movements, minimising further irritation of the fissure.
- Topical creams may assist with healing by relaxing the internal muscle and improve blood flow to the area.
Surgical Management
Some anal fissures become unresponsive to conservative management. In these cases, surgical management may be required, which focuses on relaxing the internal sphincter muscle.
Botox, which is a muscle relaxant, is commonly injected into the internal sphincter muscle. This reduces muscle spasm and pressure in the area, helping to improve blood flow and allowing the fissure to heal.
Haemorrhoids
Haemorrhoids are normal blood vessels in the anus, and everybody has them. However, when these vessels become irritated or swollen, often from straining, constipation or pregnancy, they can become symptomatic. They may appear in the anus or around the anal opening.
Types of Haemorrhoids
Internal haemorrhoids are swollen blood vessels inside the anus. They may cause bright red bleeding, often on wiping, as well as mild pain or discomfort and a feeling of incomplete bowel evacuation.
Prolapse occurs when internal haemorrhoids protrude outside the anus, often appearing as a visible lump or mass. They may cause bleeding or mucus discharge, a feeling of incomplete evacuation, anal irritation, and discomfort when sitting.
External haemorrhoids are swollen blood vessels beneath the skin around the anus and appear as a visible lump. Symptoms may include itching and irritation, pain or discomfort when sitting and bleeding.
Thrombosed haemorrhoids occurs when a blood clot forms in an external haemorrhoid, typically appearing as a firm, blue or purple lump. They can cause significant or severe pain, particularly in the first few days, bleeding, and irritation.
Conservative Treatment
Maintaining healthy bowel habits is an important part of both managing haemorrhoids and reducing the risk of recurrence. This involves ensuring a high-fibre diet, adequate water intake, and the use of fibre supplements or stool softeners, where required, to keep stools soft and reduce straining.
Various prescription topical creams are available to help manage haemorrhoid symptoms. Some contain agents that reduce inflammation and swelling, which may help relieve discomfort, while others contain ingredients that may provide temporary relief from pain and irritation.
Surgical Management
Rubber band ligation treats internal haemorrhoids and is typically performed during a colonoscopy, allowing the bowel to be examined for any underlying pathology at the same time. During the procedure, a small rubber band is placed around the base of the haemorrhoid, cutting off its blood supply.
Haemorrhoidectomy is the surgical removal of external or prolapsed haemorrhoids. As recovery can be associated with significant pain and discomfort, this procedure is generally reserved for large or complex haemorrhoids that are unresponsive to conservative treatment.
It is important to recognise that maintaining healthy bowel and lifestyle habits following surgical intervention will assist to reduce the risk of recurrence. Surgery addresses existing haemorrhoids but it does not change the underlying anatomy, meaning they can recur at any stage. Maintaining good habits as part of your daily routine is a vital part of ongoing management.