Diseases We Treat
HAEMORRHOIDS
Eruct posture is the precious gift by process of evolution. Humans developed in to a super power just because of this posture.
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FISSURE IN ANO
Anal fissure is a crack or tear in the skin at the anus (opening through which stools pass out). It may cause severe pain .
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ANAL TAGS
Here patient will be having painless, soft tissue felt on the outside of the anus. These can be the residual effect
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FISTULA IN ANO
Fistula is a tubular structure which connects two epithelialised cavities with each other or one cavity to the surface.
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PILONIDAL SINUS
Pilonidal literally means 'nest of hairs' in Latin.
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PERIANAL ABSCESS
An anal abscess is an infected cavity filled with
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CARCENOMA OF RECTUM
Bleeding is the most common symptom of rectal
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CROHN`S DISEASE
Crohn`s disease is a chronic inflammatory disease
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IBS
Symptom seen in this disease are-
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HOW A PROCTOLOGIST EXAMINS YOU ?
DIAGNOSIS
WHEN TO CONSULT A PROCTOLOGIST ?

HEMORRHOIDS :

Eruct posture is the precious gift by process of evolution. Humans developed in to a super power just because of this posture. But in due course of time it became reason for few disorders. One of them is PILES. Yes, the posture of human being contributes lot in the occurrence of the disease piles.

PILES are also called haemorrhoids (hem-uh-roids). In their normal state, haemorrhoids are cushions that help for stool control. They become a disease only when swollen or inflamed. They are either inside the anus or under the skin around the anus. They commonly result from straining during defaecation.

How common are hemorrhoids ?

  • About 75% of people will have haemorrhoids at some point in their lives. Haemorrhoids are common among ages between 45 to 65.
  • According to recent studies, 80% of population of age group between 21 to 50 yrs. will be suffering from one or other symptom of piles.
  • Haemorrhoids are also common in pregnant women & post-partum period (after delivery).
  • India has estimated 4, 07, 23,288 patients suffering from PILES. Each year, at least a million new cases are recorded, making it one of the most common health conditions.
  • Three out of four people suffer with haemorrhoids or symptoms related to it at some time in their lives. But out of these only few people require surgery. In many cases we can cure the disease with the help of medicine itself, only if patient approaches doctor in the initial stage.

Majority of patients with anal symptoms seen in a proctology clinic (Piles Clinic) complain of their haemorrhoids, but a careful history and examination by an experienced surgeon is necessary to make a correct diagnosis. Some patients will have long-standing complaints that are not attributable to haemorrhoidal disease. Other serious diseases such as anal and colorectal cancer should be ruled out by a complete examination.

CAUSES:

Piles is a growing problem in health sector especially in India because of dietary and life style factors.
Mainly, factors that increase the abdominal pressure will be the common cause for haemorrhoids.

Causes are,

  • CONSTIPATION – Chronic (Long term), frequent or severe constipation has direct impact on haemorrhoids as it causes swelling of the veins & weakness of the anal muscles.
  • DIARRHOEA – It is a reason for painful piles. It increases the chances of haemorrhoids because of straining on the anal muscles.
  • SITTING FOR LONG TIME –sitting may be on toilet or even over chairs increases pressure on the haemorrhoidal veins, causing inflammation.
  • OBESITY – The huge pressure, that fat buidup puts on the veins of the anus keeps the obese persons in risk circle of haemorrhoids.
  • DIETARY HABITS
  • DEFICIENCY OF FIBRE FOOD
  • HEREDITARY
  • IRREGULAR BOWEL HABITS
  • PREGNANCY
  • SEDENTARY WORK
  • OVER ACTIVITY OF ANAL SPINCTER
  • ANAL INTERCOURSE

Who are most prone to hemorrhoids ?

Just about everyone hashaemorrhoids at some point of time, but some things may make you more likely to get them.

Following factors increase the risk-

  • People whose parents had hemorrhoids may be more likely to get them.
  • Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth.
  • Being very overweight
  • Standing for longer duration.
  • Lifting too much can make hemorrhoids worse.

VARITIES:

INTERNAL HEMORRHOIDS -

In internal haemorrhoids there will be prolapse of anal tissue may or may not be associated with the bleeding. Prolapse means haemorrhoidal tissue coming from inside of the anal canal, which can often be felt on the outside of the anus during or after bowel movement. This tissue often goes back inside spontaneously or can be pushed back internally by the patient. The symptoms tend to progress slowly over a long time and are often intermittent.

Internal haemorrhoids are classified by their degree of prolapse. This degree helps to decide the type of treatment to be adopted.

Grade One : No prolapse outside the anus.

Grade Two : Prolapse outside the anus but that goes back in on its own

Grade Three : Prolapse outside the anus must be pushed back in by the patient

Grade Four : Prolapse that cannot be pushed back in by the patient (often very painful)

Bleeding due to internal haemorrhoids is usually bright red and can be quite brisk. It may be found over fingers while washing anal region, dripping into the toilet bowl or streaked on the stool. All patients with internal haemorrhoids will not be having bleeding as symptom. It is not a compulsory symptom. Instead, prolapse may be the main or only symptom. Prolapsing tissue may result in significant irritation and itching around the anus. Patients may also complain of mucus discharge, difficulty with cleaning themselves after passing stool, or a sense that their stool is “stuck” at the anus with bowel movement. Patients without significant symptoms from internal haemorrhoids do not require treatment based on their appearance alone.

EXTERNAL HEMORRHOIDS -

Symptomatic external haemorrhoids often present as a bluish coloured painful lump just outside the anus and they tend to occur spontaneously and may have been preceded by an unusual amount of straining. The skin overlying the outside of the anus is usually firmly attached to the underlying tissues. If a blood clot or THROMBOSIS develops in this tightly held area, the pressure goes up rapidly in these tissues often causing pain.Until & unless this thrombus develops, there will not be any pain. The pain is usually constant and can be severe. Occasionally the elevated pressure in the thrombosed external haemorrhoid results in breakdown of the overlying skin and the clotted blood begins leaking out. Patients may also complain of intermittent swelling, pressure and discomfort related to external haemorrhoids which are not thrombosed.

FISSURE-IN-ANO :

What is anal fissure ?

Anal fissure is a crack or tear in the skin at the anus (opening through which stools pass out). It may cause severe pain with or without burning after defecation and bright red bleeding. Here the main complaint of patient itself is pain & burning without any extra growth per anus.These are often thought to be due to piles. Anal fissures are common in women after childbirth, highly anxious and stressed out individuals, those on low fibre diet who strain to pass hard stools.

How is anal fissure treated ?

Some non-surgical treatmental methods are-

  • Use of dilators
  • Digital dialatation
  • Relaxation therapies
  • Sitz bath

There are some Ayurvedic procedures which readily reduce the pain & burning felt in fissure-in-ano,

  • RopanaBasti
  • Gudapichu
  • Gudavarti
  • Avagahasweda
  • Lepa

Surgery may be required for persisting scarred deep anal fissures unresponsive to the above conservative measures. It involves removal of the anal fissure (Fissurectomy) and cutting the sphincter muscle (Sphincterotomy). It is of 2 types, external & internal sphincterotomy.

ANAL SKIN TAGS :

Here patient will be having painless, soft tissue felt outside the anus. These can be the residual effect of a previous problem with an external haemorrhoid. The blood clot stretches out the overlying skin and remains stretched out after the blood clot is absorbed by the body, thereby leaving a skin tag. Other times, patients will have skin tags without an obvious preceding event. Skin tags will occasionally bother patients by interfering with their ability to clean the anus following a stool, while others just don’t like the way they look. Usually, nothing is done to treat them beyond reassurance. However, surgical removal is occasionally considered.



FISTULA-IN-ANO :

Fistula is a tubular structure which connects two epithelialised cavities with each other or one cavity to the surface. It is lined by an unhealthy granulation tissue and chronic fibrous material and often communicates with the large abscess cavity which is filled with purulent discharge and is drained inadequately but constantly through the narrow tubular passage. A fistula can also connect the two natural cavities having mucosal lining in which case it is termed according to the organs to which it communicates.

Fistula is commonly having two openings. Primaryopening and secondary opening. In case of fistula of anal canal(fistula-in-ano) primary opening is inside anal canal and secondary opening in the perianal(around anus) skin. Secondary tracts may be multiple and can extend from the same primary opening. It should be differentiated from the following processes, which do not communicate with the anal canal. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.

Treatment methods –

  • Fistulectomy
  • Kshara sutra
  • Cryosurgery

PILONIDAL SINUS :

Pilonidal literally means 'nest of hairs' in Latin. A pilonidal disease/ infection/ abscess/ cyst/sinus (PNS) is a common problem of young men and less often women. Pilonidal disease is associated with visible pits in the midline of the natal cleft and is more common among the profusely sweating hirsute, the obese, and those with sedentary occupation or who travel a lot. It occurs in the cleavage between the buttocks (natal cleft). Initially it may be a painless lump or swelling. It often causes discomfort, embarrassment and absence from work. When infected it causes pain and discharge.

How is Pilonidal sinus treated ?

The best suited therapy for this is the KSHARA SUTRA ligation. A medicated alkaline thread(Kshara sutra) is passed through the dependent points of the sinus and tied outside. Every weak this thread is replaced by new medicated thread(Kshara sutra). This will provide drainage for the collected secretion along with growth of healthy tissue. Advantage of this treatment is, procedure is completed without wide opening of sinus. Hence there will be will be very less chances of external cross infection and patient can be treated on outpatient basis without hospitalization. Also patient can go through his/ her routine work.

Another new method advisable is CRYOSURGERY. Here the sinus will be opened, all unhealthy tissues are removed and wound will be treated with cryo therapy. This method is better suited for small pilonidal sinuses.

It is treated with antibiotics, pain relieving drugs and surgery to remove the infected material and if possible all the skin pits in the natal cleft. In severe infection a second surgery may require for this. The surgeon may choose to leave the wound open or close it or use plastic surgery. All these procedures are very painful & with slight negligence there will be reoccurrence of the problem.

PERIANAL ABSCESS :

An anal abscess is an infected cavity filled with pus found near the anus. 90% of abscesses are the result of an acute infection in the internal glands of the anus. Occasionally, bacteria, faecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess.




CARCENOMA OF RECTUM :

Bleeding is the most common symptom of rectal cancer, occurring in 60% of patients. Bleeding may be accompanied by the passage of mucus, which needs further investigation for confirmation of disease. Occult bleeding is detected via a faecal occult blood test (FOBT) in 26% of all cases.




CROHN`S DISEASE :

Crohn`s disease is a chronic(persistent) inflammatory disease which can occur anywhere in the gastrointestinal tract from the mouth to the rectum.

Symptoms include: Blood in stools, diarrhoea, urgency to defecate, rectal bleeding, fever, pain in abdomen




IBS – IRRITABLE BOWEL SYNDROME :

Symptom seen in this disease are:

  • Fullness of stomach before eating a meal
  • Indigestion
  • Heartburn
  • Reflux
  • Constipation
  • Alternating diarrhea or constipation
  • Abnormal bowel urgency
  • Abnormal bowl frequency
  • Hemorrhoids
  • Pain
  • Spasms

HOW A PROCTOLOGIST EXAMINS YOU-

Before having a rectal examination, your doctor will explain the procedure to you. You'll be asked to remove your lower clothing. You'll be asked to lie on a couch, on your left side, and to bring your knees up towards your chest. This is called Left lateral position.

If required your doctor may examine you in Lithotomy position. It is a supine position of the body with the legs separated, flexed and supported in raised stirrups.

Your doctor will begin by making a careful visual examination of your anus. They'll look for any abnormalities, such as :

  • warts, rashes, swollen blood vessels around the anus or rectum
  • damage to the anus, such as a tear in the lining (anal fissure)

Your doctor will put a glove on one hand and use a gel to lubricate one of their fingers. They'll gently push the finger into your anus and then up into your rectum. You may feel a little discomfort or pain at this stage of the examination. During the rectal examination, you may be asked to squeeze your rectum around their finger so that they can assess how well the muscles in your rectum and bowels are working.

If examining a man, the doctor may also firmly press against the prostate gland. A healthy prostate gland should be smooth to the touch, so they'll check for any hard or lumpy areas, which may indicate the presence of prostate disease, such as prostate cancer. Pressing on the prostate gland doesn't hurt, but it may make you feel like urinating. If there's an infection, the prostate may feel tender when it's pressed.

DIAGNOSIS :

  • Inspection : External examination of anus by doctor.
  • Digital examination - placement of a finger through the anus into the rectum
  • Per rectal examination (Proctoscopic examination) - placement of a finger-sized instrument through the anus to allow visual inspection of the haemorrhoidal tissue. Proctoscopy is a common medical procedure in which an instrument called a proctoscope is used to examine the anal cavity. During proctoscopy, the proctoscope is lubricated and inserted into the rectum, and then the obturator is removed, allowing an unobstructed view of the interior of the rectal cavity. This procedure is normally done to inspect for haemorrhoids or rectal polyps.
  • Colonoscopy
  • Sigmoidoscopy

When to consult a PROCTOLOGIST ?

  • Bleeding per rectum - during or after defecation
  • Pain - during defeacation which may sometimes continue a short while or a long period even after defeacation.
  • Burning sensation – during and/ or after defeacation.
  • Constipation – which may be persistent
  • Mucous discharge – i.e. discharge of some sticky substance along with feaces
  • A feeling of dissatisfaction even after defeacation
  • Protrusion of mass coming out of anus while defeacation
  • Abscess – recurrent abscess formation near the anal region, sometimes burst resulting in pus discharge
  • Prolonged lack of appetite, indigestion, anaemia, chonic backache & bodyache, cramps in calf muscles
  • A discharge from the anus, possibly an STD (sexually transmitted disease) is present.
  • A painful, red swelling on the buttocks which may be an abscess (a collection of pus).
  • You have been told that you are anemic and that the source of the anemia (a low red blood cell count), may be in your colon, rectum or anus.
  • You have turned 50 years old and need a screening colonoscopy.
  • You have a strong family history of colon polyps or colorectal cancer and you need an evaluation for a genetic disorder.

IF YOU HAVE THESE SYMPTOMS WHAT YOU HAVE TO DO ?

Consult a PROCTOLOGIST(A doctor who studies and treats disorders of the rectum and anus)

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