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Proctology Clinic
Proctology Clinic
Recently, anal diseases are continue to increase associated with westernized diet. However, there are still many people who neglect treatment due to embarrassment and misinformation.
At Proctology Clinic, Shihwa Medical Center, we provide sufficient counseling and conservative treatment or minimally invasive surgery tailored to the individual patient for anal diseases that interfere with daily life, to provide highly-satisfying medical services.
Hemorrhoids
Usually, all diseases that occur in the anus are called hemorrhoids. Hemorrhoids can also be considered as a typical symptom of anal disease. Hemorrhoids refers to a condition in which blood vessels and mucosal tissues protrude due to vascular expansion in the anus and reduced supporting capacity of the surrounding submucosal tissue. Internal hemorrhoids are lumps that develop inside the anus and external hemorrhoids develop outside the anus. They usually appear together as mixed hemorrhoids. In most cases, the lump is asymptotic, but it can cause bright red bleeding, itching, and severe pain.
Cause of hemorrhoids
Hemorrhoids occur due to genetics, bowel habits, and environmental factors. For women, constipation occurs after pregnancy, childbirth, or while on a diet, and for men, the symptoms appear if they overwork or drink alcohol too much. Hemorrhoids also form when blood vessels sag with age, when standing for a long time, or sitting for too long to defecate. Anatomical abnormalities of the anus or family history can also be a cause.
Classification of hemorrhoids
Dentate line: a serrated border located about 1.5 cm medially from the entrance to the anus
| Internal hemorrhoid |
Hemorrhoids in the upper dentate mucosa The mucosal tissue above the dentate line, where internal hemorrhoids develop, is loosely attached to the anal wall, compared to the skin tissue. So, when internal hemorrhoids grow to a certain extent, they protrude out of the anus during defecation, resulting in 'prolapse'. Since the mucosal tissue is weak compared to the skin, bleeding occurs when a wound occurs. However, since the sensory nerves are not there, most patients with internal hemorrhoids do not feel any pain. |
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| External hemorrhoids |
Hemorrhoids in the lower dentate mucosa The lower part of the dentate line, where external hemorrhoids occur, is covered with hard skin compared to the mucous membrane, so it does not easily bleed and prolapse. However, as the external hemorrhoids grow larger, the stretched skin is palpated outside the anus, resulting in a ‘skinfold'. Or, if a blood clot occurs in the subcutaneous tissue due to bleeding in the skin, the external hemorrhoids suddenly swell, resulting in severe pain. |
Treatment of hemorrhoids
Not all hemorrhoids are treated with surgery. Even if left untreated for a long time without surgical removal, it does not progress to serious diseases such as cancer, so conservative treatment is preferred. It is essential to take a hot sitz bath, improve eating habits, and manage bowel habits. However, a surgical treatment is recommended if pain or itching interferes with daily life.
Fistula and anal abscess
An anal abscess, an acute state, refers to the formation of a collection of pus due to bacterial infection from the mucus-secreting glands (anal glands) in the rectum and around the rectum. Fistula is often results from previous anal and rectal abscess complications. It is a chronic condition in which a small tunnel develops from the pus created by the abscess to the skin of the buttocks around the outside of the anus.
| Causes | There are about 6-8 anal glands in the anus that lubricate for smooth bowel movements. These are infected by bacteria, creating an infectious lesion (primary fossa) within the internal and external sphincter, which in turn forms a fistula. It can also occur in patients with chronic diseases such as anal fissure, actinomycosis, Crohn's disease, and diabetes after surgery or trauma in the anal region. |
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| Symptoms | A fistula or fistula abscess should be suspected in the following cases: (1) the area around the anus becomes red and swollen, or a part of the anus suddenly becomes hard to touch, (2) if you feel a sense of heat in your body and feel chills as if you have a body aches, and there is a hole in your anus where the pus comes out, or (3) if the anus is painful and it is suddenly difficult to urinate. |
| Treatment | Surgical treatment must be accompanied by drug treatment. Anal abscesses are sometimes treated with incision and drainage. For fistulas, the sphincter that tightens the anus must be partially cut. However, depending on the situation, if possible, a surgical method that does not involve cutting the sphincter should be preferred. |
Anal fissure
A laceration in the anus is called anal fissure, resulting in severe pain and blood in the stool during bowel movements. The age of onset varies widely, but it is particularly prevalent in young adults. It occurs most often posterior to the anus, and in rare cases, it may also occur anteriorly. Acute fissure only scars, but chronic fissure shows deep-seated ulcers and inflammatory skin bumps outside the anus. People with frequent anal tear should seek treatment without delay.
| Causes | When you pass a hard and thick stool, the skin inside the anus is torn and becomes a fissure. In addition, it occurs when there is frequent diarrhea or an inflammatory disease of the anorectal region. In the acute phase, there is only bleeding and pain, but over time, the skin protrudes out, the mucous membrane thickens, and the pain becomes chronic. |
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| Symptoms | If there is a tear felt in the anus while having a bowel movement and symptoms of dripping blood, an anal fissure is suspected. The pain may go away within a few minutes, or last for hours or all day. The fear of pain during defecation keeps you from defecating, which only makes it worse. Chronic fissure results in a characteristic skin tags outside the anus. If the fissure is repeated, it will get bigger and a polyp may form in the anus and protrude out during defecation. |
| Treatment | Early anal fissure usually improves on its own if warm water sitz baths and laxatives are used to make it easier to pass soft stools. However, long-term symptoms and chronic fissure continue to cause pain and bleeding even with normal stools. Such chronic fissure should be treated with surgery in which a part of the internal sphincter that has lost elasticity is cut off. |
Anal pruritus
Anal pruritus is a persistent or intermittent severe itching of the anus and the skin around the anus or vulva due to various causes. Anal pruritus is a symptom, not a disease. These symptoms appear because there is an abundance of nervous tissue around the anus that is sensitive to any stimulus. It is more common in people who are overweight, sweat a lot, and wear tight underwear. Not all who have anal pruritus have an anal or rectal disease.
| Causes | Anal pruritus can be caused by systemic diseases such as diabetes, liver disease, allergies, etc., pinworm disease, mycosis, and anal diseases (hemorrhoids, dentition, etc.). Other causes include skin irritation caused by loose stools or diarrhea, food (spice, coffee, chocolate, alcohol, etc.), and stress. Heavy rubbing around the anus or frequent washing with soap can also lead to anal pruritus. |
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| Symptoms | Anal pruritus causes unbearable itching in the anus or the skin around the anus, perineum, and vulva. The itching leads to scratching, turning the skin around the anus red. These symptoms often get worse at night and interfere with sleep. When it becomes chronic, the skin around the anus peels off due to repeated scratching. It can also become painful or the skin around the anus may thicken and become leathery. Repeated scratching may also damage the skin of the anus, resulting in painful localized infections. |
| Treatment | Anal pruritus can occur due to a variety of causes. Therefore, it is important to get anus examination and then receive appropriate treatment according to the cause of the disease. If the pruritus is due to an anal disease such as fistula, fissure, hemorrhoids, or anal polyps, it should be treated first. In the treatment of pruritus, maintaining cleanliness around the anus is the most basic and important treatment. After a bowel movement, wash with clean water and pat dry with a dry towel. Avoid using soap or rubbing with tissue when wiping the anus. Wear loose-fitting, sweat-wicking cotton underwear. Scratching the anus makes symptoms worse, so when itchy, taking a sitz bath is recommended. |
Management of anal diseases
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- Do not sit on the toilet for more than 5 minutes.
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- Wash your anus with a bidet or take a shower whenever possible after a bowel movement.
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- Consume enough fluids and fiber to avoid constipation.
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- Avoid sitting in cold places.
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- Take a break in long sedentary work.
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- Refrain from irritating foods such as alcohol and coffee.