Surgery for Anal Diseases

Types of Anal Conditions

Medical conditions of the anus, the opening at the end of the gastrointestinal tract through which stools are expelled from the body, are fairly common and easily treatable. However, many people delay seeking medical assistance, more often due to embarrassment. While most anal conditions are minor and go away on their own, some can be debilitating if left untreated.

There are numerous anal disorders, the most common of which are:

  • Anal Fissures

    These are tears in the anal lining that typically result from passing large and hard stools. They are characterized by an itchy sensation, severe pain and bleeding during bowel movements.

  • Hemorrhoids

    These refer to swollen veins that develop in the anorectal area and are caused by factors such as excessive straining during bowel movements, obesity, pregnancy and genetics. It is one of the most common causes of rectal bleeding alongside anal fissures.

  • Anal Fistula

    This is a small “tunnel” that forms from within the anus to the skin around it on the outside. It is usually a result of a drained abscess that failed to heal properly.

  • Anal Abscess

    This is a collection of pus-filled sacs that form near the anus. It is commonly caused by an infection or blockage in the anal glands.

  • Bowel Incontinence

    This refers to difficulty controlling one’s bowel movements. It is often a result of muscle or nerve damage, which are often caused by aging, childbirth, pelvic floor disorders and other conditions.

  • Anal Cancer

    This occurs when tumours or abnormal cancer cells develop in and spread from the anus. Most cases of anal cancer (as well as cervical, penile and oral cancers) are reported to be caused by the human papillomavirus (HPV).

Apart from anal fistulas, initial treatments for these conditions include diet and lifestyle adjustments, and medications. If these prove to be insufficient, especially when the condition has turned chronic, surgery will then be recommended.

  • Anal Fissures

    Using a procedure known as lateral internal sphincterotomy (LIS), an incision is made in the internal sphincter muscle to reduce pressure and facilitate blood flow to the fissure, which promotes quicker healing. It is a very effective method with a success rate of up to 95%. Alternatively, Botox injections may also be used to treat chronic anal fissures.

  • Hemorrhoids

    Larger and prolapsed hemorrhoids that do not respond to non-surgical treatments are simply excised through a method called hemorrhoidectomy. Prolapsed hemorrhoids may also be treated via hemorrhoidopexy, in which the hemorrhoid is stapled back into place inside the rectum, and its blood supply cut off to shrink it. Some forms of hemorrhoids surgery, including banding, sclerotherapy and coagulation therapy, do not require sedation and are used to retract or shrink the hemorrhoid by cutting off its blood supply.

  • Anal Fistula

    There are two methods used to treat anal fistulas: fistulotomy (the fistula is further cut open to enable healing) and fistulectomy (the fistulous tract is entirely removed). For more serious forms of fistulas, a seton (surgical thread), rectal tissue or a prosthetic plug may be inserted to drain abscesses and plug the abnormal tunnel.

  • Anal Abscess

    The most common and effective way to treat an anal abscess is through surgical drainage. An incision is made in the sac to allow the pus to drain out. Proper care and hygiene must be done following the operation to prevent anal fistulas.

  • Bowel Incontinence

    Sphincteroplasty is a reconstructive operation in which the sphincter muscles are sewn in an overlapping manner, making the sphincter tighter and stronger. In some cases, muscle from the thighs are sewn around the sphincter to improve muscle tone (dynamic graciloplasty). If the sphincter is damaged beyond repair, it may be replaced with an artificial one.

  • Anal Cancer

    Tumors that have not spread beyond the anus may be removed through local resection. This involves removing the tumors along with their surrounding tissues. However, the sphincter is left intact, allowing for regular bowel movements. However, an abdominoperineal resection would involve the removal of both anus and anal sphincter. It is performed to treat tumors that are recurrent and unresponsive to other forms of treatment. In such cases, a colostomy will be done to allow for bowel movements.

Piles surgeon Dr Dennis Koh specializes in the management of colorectal and anal disorders and employs minimally invasive methods for cancer, hernia and hemorrhoids treatment. For more information about Colorectal Practice’s services, call +65 6262 1226 today.

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