Proctological diseases

Overview

There is an area of colon and rectal health that everyone should be familiar with, encompassing a wide range of illnesses and disorders that can be moderately annoying to life-threatening. Illnesses of the rectum and anus (anorectal disorders) and diseases of the colon and rectum (colorectal disorders) are frequent, and the frequency in the general population is most certainly larger than we realize.

This is due to the fact that many persons suffering from these ailments do not seek medical attention. That's understandable. It might be awkward to discuss concerns in these areas.

 

What are Proctological diseases?

Proctological illnesses are a set of medical conditions that develop at the anal canal-rectum junction. One challenging aspect of several of these conditions is that their symptoms can be quite similar to those of other diseases, raising the possibility of misdiagnosis and mistreatment. This is why it is critical that you seek the advice of professionals in colon and rectal surgery and nonsurgical therapy.

 

What is Proctology?

Proctology is the study of illnesses of the colon, rectum, or anus. The most common ailment is anal fissure, which causes discomfort and blood during bowel movements. Furthermore, irritable bowel syndrome and inflammatory bowel illnesses are common proctological diseases in Pakistan.

These disorders significantly impede patients' daily activities and might have a negative impact on their quality of life. The most significant component in the treatment of proctological illnesses is early detection.

 

What is a Proctologist?

Proctologists are surgeons who diagnose and treat rectum, anus, and gastrointestinal system problems. However, the term "proctologist" is a little out of date. The recommended phrase these days is "colorectal surgeon" or "colon and rectal surgeon." Continue reading to find out more about these highly educated professionals, the problems they diagnose and treat, and the warning signals that you should visit one.

 

Hemorrhoids

Hemorrhoids are enlarged veins in the rectum or anus. The location of the hemorrhoid determines the kind.

• Internal hemorrhoids involve the veins inside your rectum. Internal hemorrhoids usually don’t hurt but they may bleed painlessly.
• Prolapsed hemorrhoids may stretch down until they bulge outside your anus. A prolapsed hemorrhoid may go back inside your rectum on its own. Or you can gently push it back inside.
• External hemorrhoids involve the veins outside the anus. They can be itchy or painful and can sometimes crack and bleed.
  
  

Symptoms of hemorrhoids

You may notice a painful lump on the border of your anus if you have a hemorrhoid. It is also possible to see blood on the toilet paper after wiping or in the toilet after a bowel movement. You may get itching in that location. You may also experience pain. Pain is most common after a bowel movement or vigorous activity, such as lifting something heavy.

How are hemorrhoids diagnosed?

If you have hemorrhoid, you probably already know. Hemorrhoids are frequently diagnosed simply by looking. However, if you have internal hemorrhoids, a doctor can confirm it with a simple inspection. He or she will feel in and around your rectum with a gloved, lubricated finger. A sigmoidoscopy may also be ordered by your doctor. During a sigmoidoscopy, he or she will introduce a tiny camera into your rectum to examine it. They may also do an anoscopy. To inspect the anal canal, a tiny device called an anoscope is introduced a few inches into the anus.

If you discover bleeding from your rectum, you should visit your doctor right away. You must ensure that the reason is hemorrhoids and not something else. Bleeding from your rectum or anus, as well as bloody stools, may indicate something more serious, such as malignancy.

Can hemorrhoids be prevented or avoided?

Hemorrhoids affect almost everyone at some point in their lives. However, several factors may increase your chances of getting them. People who have hemorrhoids in their families are more prone to develop them. Hemorrhoids are common in pregnant women due to the pressure of carrying the baby and giving birth. Being extremely overweight, as well as standing or lifting excessively, might aggravate hemorrhoids.

Hemorrhoid treatment

Even without therapy, hemorrhoid symptoms usually go away within a few days. If not, therapy focuses on pain relief. Before utilizing hemorrhoid medication, see your primary care physician. If you have hemorrhoids, here are some things you can do to help:

• Take warm baths.
• Clean your anus after each bowel movement. Do this by patting gently with moist toilet paper or moistened pads, such as baby wipes.
• Use ice packs to relieve swelling.
• Use acetaminophen (1 brand name: Tylenol), ibuprofen (1 brand name: Motrin), or aspirin to help relieve pain.
• Apply a cream that contains witch hazel or a numbing ointment that contains lidocaine to the area. You can use creams that contain hydrocortisone for itching or pain.

Painful hemorrhoids normally go away on their own after 1 to 2 weeks. If yours continues to cause issues, consult your doctor. Internal hemorrhoids can be treated with rubber band ligation. It entails wrapping a little rubber band around the hemorrhoid's base. The flow of blood to the region is stopped, and the hemorrhoid withers away. Internal hemorrhoids can be eradicated by injecting a chemical into them. If your internal hemorrhoids are prolapsed or particularly big, you may require a hemorrhoidectomy (surgical removal of the hemorrhoid).

 

Anal fissures

The anal canal is a small tube at the end of your rectum that is bordered by muscle. The rectum is the colon's bottom part (large intestine). An anal fissure is a minor rupture or tear in the anal canal lining. Fissures are common, however they are frequently mistaken with other anal disorders like hemorrhoids.

 

CAUSES OF ANAL FISSURE

Fissures are typically generated by damage to the anus's inner lining from a bowel movement or other straining of the anal canal. This might be caused by a firm, dry bowel movement or by numerous, loose bowel motions. Anal fissures are more prevalent in patients who have a tight anal sphincter muscle. Fissures can also be caused by inflammatory bowel disease, anal infections, trauma, or malignancies. 

 

SYMPTOMS

Anal fissures often induce an acute discomfort that begins with stool transit. This discomfort might last anywhere from a few minutes to a few hours. As a result, many individuals may try to avoid bowel motions to avoid pain.

Other symptoms include:

• Bright red blood on the stool or toilet paper after a bowel movement
• A small lump or skin tag on the skin near the anal fissure (more common when chronic or having been present for greater than 6 weeks)
  

 

NONSURGICAL TREATMENT

Your physician will discuss the benefits and side effects of treatments.

Treatment includes:

• A high-fiber diet and over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed, and bulky.
• Over-the-counter stool softeners to make stools easier to pass.
• Drinking more water to help prevent hard stools and aid in healing.
• Warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day (especially after bowel movements to soothe the area and help relax anal sphincter muscles). This is thought to help the healing process.
• Medications, such as lidocaine, that can be applied to the skin around the anus for pain relief.
• Medications such as diltiazam, nifedipine, or nitroglycerin ointment to relax the anal sphincter muscles which helps the healing process.
• Narcotic pain relievers are avoided since they might produce constipation, which can exacerbate the condition.
  

 

SURGICAL TREATMENT

Although most anal fissures do not require surgery, persistent fissures are more difficult to heal and may necessitate surgery. The surgery's purpose is to relax the anal sphincter muscles, which decreases discomfort and spasms and allows the fissure to heal. Botulinum toxin (Botox®) injection into the anal sphincter or surgical division of an inner section of the anal sphincter are surgical possibilities (lateral internal sphincterotomy). Your colon and rectal surgeon will choose the best therapy for you and will go over the risks of surgery with you. Both forms of surgery are frequently performed as outpatient operations on the same day.

 

Diverticular disease

Diverticulosis is a disorder in which pouches (diverticula) form in the colon's wall (large intestine). These pouches are often extremely tiny in diameter (5 to 10 mm). They can, however, be bigger.

The pouches in the colon wall do not induce symptoms in diverticulosis. The illness may not be discovered until symptoms appear, as in painful diverticular disease or diverticulitis. Diverticulitis does not affect up to 80 percent of patients who have diverticulosis. Diverticulosis is frequently detected only after testing to determine the origin of another medical disease or during a screening visit.

 

What causes it?

The exact cause of pouches (diverticula) forming in the colon wall is unknown. Diverticula are thought to arise when high pressure inside the colon presses against weak places in the colon wall.

A diet high in fiber (also known as roughage) produces bulky stool that moves easily through the colon. In order to move small, hard stool, the colon must exert more pressure than usual if the diet is low in fiber. A low-fiber diet can also lengthen the time feces sits in the gut, contributing to elevated blood pressure.

When strong pressure pulls against weak regions in the colon where blood vessels penetrate through the muscular layer to give blood to the inner wall, pouches can develop.

 

What are the symptoms?

The majority of people have no symptoms. By the time symptoms appear, you may have had diverticulosis for years (if they do). Some people get an infection in their pouches over time (diverticulitis).

Your doctor may refer to your condition as painful diverticular disease. Irritable bowel syndrome is most likely the cause of painful diverticular disease. Symptoms include diarrhea and cramping abdominal (belly) pain, with no fever or other sign of an infection.

 

How is it diagnosed?

Diverticulosis is frequently identified only after procedures, such as a barium enema X-ray or a colonoscopy, are performed to determine the origin of another medical condition or during a screening check.

How is diverticulosis treated?

The best way to treat diverticulosis is to avoid constipation. Here are some ideas:

• Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fibre.
• Drink plenty of fluids.
• Every day, get some exercise. Aim for at least 212 hours of moderate to strenuous exercise every week. It's good to be active in 10-minute increments throughout the day and week.
• If necessary, use a fibre supplement such as Benefibre or Metamucil every day. 
• Make time each day to have a bowel movement. A daily regimen may be beneficial. When having a bowel movement, take your time and don't strain.

This medication may aid in the prevention of new pouches (diverticula) and the danger of diverticulitis.

 

Eating, Diet, & Nutrition

If you have chronic diverticular disease symptoms or have had diverticulitis in the past, your doctor may advise you to consume more fiber-rich foods. Whole grains, fruits, and vegetables are high in fiber.

 

Anal abscess and fistula

An anal abscess is a pus-filled infected cavity near the anus or rectum. An anal fistula (also known as a fistula-in-ano) is a short tunnel that runs from a hole within the anal canal to a hole in the skin around the anus. An anal fistula is frequently caused by a prior or ongoing anal abscess. A fistula can develop in up to 50% of persons who have an abscess. A fistula can, nevertheless, develop in the absence of an abscess.

 

Anal Fistula Causes

Normal anatomy includes small glands just inside the anus. An infection can occur if the glands in the anus become clogged. When the infection is severe, it frequently results in an abscess. Bacteria, excrement, or foreign substances can potentially obstruct the anal glands and lead to the formation of an abscess. Infections and fistulas can be exacerbated by Crohn's disease, cancer, trauma, and radiation.

SYMPTOMS

A patient with an abscess may experience discomfort, redness, or swelling in the anal region or canal. Other typical symptoms include feeling unwell or exhausted, as well as fever and chills. Fistula patients experience comparable symptoms, as well as discharge from an incision near the anus. If similar symptoms reoccur in the same region every few weeks, a fistula is suspected.

DIAGNOSIS

Clinical findings are used to diagnose and treat the majority of anal abscesses and fistulas. Imaging investigations such as ultrasound, CT scan, or MRI may be utilized to see the fistula tunnel and aid in the diagnosis and management of deeper abscesses.

TREATMENT

In most cases, surgical drainage is used to treat an abscess. It is critical that your surgeon has extensive experience treating abscesses and fistulas. Colorectal surgeons are specialists in this field. Most people can have an abscess surgically drained with a simple procedure. To drain the infection, an incision is made in the skin around the anus. This procedure can be performed in your surgeon's office under local anaesthetic or in an operating room under general anesthesia. Some people with more severe condition may need numerous procedures to resolve the issue. Patients who are prone to more severe infections owing to diabetes or immune deficiencies may require hospitalization.

Anal fistulas are almost typically treated surgically. A fistulotomy is performed in many people if the fistula is not too deep. The fistula track will be opened during this procedure to facilitate healing from the bottom up. A tiny section of the sphincter muscle may need to be divided as part of the procedure. A major portion of the sphincter muscle is not separated, which might contribute to bowel control issues (fecal incontinence). If the fistula track involves a significant amount of the sphincter muscle, further more complex operations are performed to repair the fistula without causing injury to the sphincter muscle. In more challenging instances, numerous procedures may be required.

Antibiotics alone are ineffective in the treatment of abscesses and fistulas. If a patient has immune problems, certain heart valve abnormalities, or extensive cellulitis, antibiotics may be required in addition to surgery (a bacterial infection of the skin and tissues under the skin). Giving your doctor an accurate medical history and having a physical exam are key stages in determining if antibiotics are needed.

 

Pruritus ani 

Itching around the anal area is known as pruritus ani, and it is generally particularly bothersome at night or after a bowel movement. Excessive cleaning or wiping, as well as excessive perspiration in the anal region, are common reasons. Some beverages, such as alcohol, citrus, and caffeine-containing beverages, may aggravate pruritus ani. Poor hygiene is seldom the cause. 

 

Rectal bleeding

Rectal bleeding can be caused by a variety of illnesses, but all cases should be investigated to determine the reason. Cancers and polyps, for example, might bleed on a regular or sporadic basis. Hemorrhoids, fissures, and polyps are the most prevalent causes of rectal bleeding. Older age, a family history of bowel illness or cancer, and the failure of the bleeding to stop following therapy for the apparent cause are all risk factors that frequently prompt additional evaluation. A colonoscopy may be necessary for a complete colon examination.

 

Inflammatory bowel disease

• Ulcerative colitis - This is a big intestine inflammatory illness (colon). Symptoms include gastrointestinal bleeding, stomach discomfort or bloating, constipation, diarrhea, or a combination of these. To confirm the diagnosis, we may do a flexible sigmoidoscopy or colonoscopy and obtain samples of the colon wall. While there is currently no medical treatment for ulcerative colitis, we can treat symptoms with medication and do surgery to cure the condition.
  
  
• Crohn's disease - Crohn's disease is a chronic inflammatory disorder that mostly affects the intestine. A physical examination, study of symptoms, and family history are used to diagnose Crohn's disease. A sigmoidoscopy, colonoscopy, or radiographic examinations may be performed. The preferred initial method of therapy is anti-inflammatory or immunosuppressive medicine to manage symptoms, although surgery to remove the diseased section of the colon may be suggested in more severe or difficult cases.

 

Irritable bowel syndrome (IBS)

IBS is a widespread condition of intestinal muscle function that causes constipation, diarrhea, bloating, discomfort, cramping, or a combination of these symptoms. Because the symptoms of IBS are so similar to those of other, potentially fatal disorders, such as colon cancer, we strongly advise you to seek medical assistance. Increasing the amount of liquids and bulk-forming items in the diet to soften stools may give comfort, but if this does not work, doctors may prescribe drugs to assist restore regular intestinal muscle contractions.

 

Anal carcinoma

Rectal cancer is commonly associated with other illnesses, such as HIV or HPV. These tumors are more common in women who have cervical dysplasia (changes in the cervix). Small tumors can be surgically removed, while larger tumors require chemoradiotherapy.

 

Conclusion 

Proctological illnesses mostly affect the lower digestive system; to treat these conditions, corrective colorectal procedures to repair the colon, rectum, or anus are done. Piles, hemorrhoids, fissures, and fistulas are all disorders that, if left untreated, can lead to serious consequences. Colectomy, ileo/colostomy, polypectomy, strictureplasty, hemorrhoidectomy (in severe instances of hemorrhoids), anoplasty, and other surgical therapies are available based on the patient's health and symptoms.