Specialist Perianal Surgery Perth
Common perianal conditions, their symptoms, diagnosis, and treatment options.
Perianal conditions affect the skin, soft tissues, and structures surrounding the anus. These conditions are common and can cause pain and significant discomfort, often affecting daily activities and quality of life.
As a colorectal surgeon, Mr Stein provides specialist assessment and treatment for haemorrhoids, anal fissures, anal fistulae, perianal abscesses, skin lesions, and other perianal conditions. His approach focuses on accurate diagnosis, symptom relief, promoting healing, and reducing the risk of recurrence.
While many conditions can be managed with simple treatment, others require specialist assessment to determine the underlying cause and ensure the most appropriate management. Early diagnosis can help prevent symptoms from worsening and avoid ongoing complications.
Symptoms Requiring Assessment
You may benefit from specialist assessment if you experience:
- Persistent anal or rectal pain, including throbbing, aching, or sharp pain.
- Bright red bleeding during or after a bowel motion.
- A lump, swelling, or discharge around the anus.
- Recurrent perianal abscesses.
- Difficulty maintaining hygiene or pain when sitting.
Severe pain, a rapidly enlarging or tender lump, fever, and increasing redness and swelling around the anus requires assessment at your nearest Emergency Department. These symptoms may indicate an infection or abscess requiring urgent treatment.
Treatment Approach
Treatment options may include conservative measures such as dietary and lifestyle modifications, medication, and topical therapies. Where appropriate, minor procedures or surgery may be recommended to provide lasting symptom relief and restore comfort.
Anal Fistula
An anal fistula is an abnormal tunnel connecting the internal anal canal to the external skin surrounding the anus. A fistula will typically develop following a previous, unhealed abscess.
Common Symptoms
- Continuous or intermittent discharge of pus, blood, or fluid from an opening near the anus.
- Pain and swelling often builds up as fluid accumulates and may subside once the tract bursts and drains.
- Skin irritation such as scaling, redness, and itching.
- Systemic symptoms such as recurrent fevers and general fatigue if an active infection builds.
Conservative Management
Conservative treatment often involved regular salt baths to soothe irritation and encourage drainage, and short-term antibiotics to manage infections or abscesses.
Surgical Management
- LIFT Procedure – The space between the sphincter muscles is accessed and the fistula tract is tied off and divided, without cutting the muscle.
- Seton Placement – A seton is placed through the fistula tract to keep it open. This allows for drainage and infections to resolve whilst preventing new abscesses forming.
- Fistula Plug – A plug is inserted into the tunnel to seal it shut, allowing tissue to grow over and close the tract.
Anal Fissure
An anal fissure is a small tear or cut in the lining of the anal canal. It is most frequently caused by the trauma of passing hard or large bowel movements.
Common Symptoms
- Pain described as sharp, stabbing, cutting, or burning, often during bowel movements.
- Spasms of the internal sphincter muscle caused by pain, often lingering for minutes to hours after using the bathroom.
- Bright red bleeding typically on the surface of the stool, toilet bowl or toilet paper.
- Skin tags (a small lump of skin) may develop from chronic fissures.
Conservative Management
- Dietary and lifestyle modifications such as increasing fibre and water intake, and stool softeners to ensure bowel movements are easy to pass.
- Topical creams assist with temporarily relaxing the internal sphincter muscle and increasing circulation.
Surgical Management
Botox injections to the sphincter muscle, temporarily paralysing the muscle which stops the spasms and allows the fissure to heal.
Haemorrhoids
Haemorrhoids are cushions of blood vessels and connective tissue around the anal canal that have become swollen and inflamed, which can present internally or externally.
Common Symptoms
- Prolapsed haemorrhoids can protrude outside the anus, often during straining. They may slip back on their own or require manual pushing.
- Painless, bright red bleeding during bowel motions is commonly caused by internal haemorrhoids.
- Thrombosed haemorrhoids occur when a blood clot forms inside the vessel (appears as a hard, dark lump), causing significant pain.
- Pruritus and mucus secreted from dislodged or bulging tissue. This may lead to itching, wetness, and discomfort.
Conservative Management
Dietary and lifestyle modifications such as good bowel habits (avoiding straining and prolonged sitting) and ensuring adequate fibre and water intake. Prescription topical creams and suppositories are often trialled to reduce swelling, itching, and discomfort.
Surgical Management
- Rubber Band Ligation – A tiny rubber band is placed around the base of internal haemorrhoids, cutting off the blood supply.
- Haemorrhoidectomy – The definitive surgical removal of severe, large, or complex haemorrhoids. This procedure is typically reserved for cases that don’t respond to conservative methods.
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