Pile, Fissure, Fistula In Ano


Pile In Ano

Piles otherwise called haemorrhoids,is a very common problem among adult population. Piles normally present as painless bleeding per rectum especially after passing motion. Anyone with passage of blood per rectum should see a surgical specialist. This is not to miss a cancer lurking in the rectum or colon. Severe degree of piles protrude from the rectum and sometimes need to be manually pushed back. Protruding pile masses will require surgical treatment. Smaller piles may get cured with injection sclerotherapy or piles banding. Piles surgery can be performed by stapler technique, harmonic scalpel, Doppler guided hemorrhoidal artery ligation etc..and all these procedures are essentially day care operations.

Fissure In Ano

Fissure-in-ano depicts a break in the lining of the anus due to extreme stretch during passage of a large hard motion. Severe pain in that area will cause spasm of the anal sphincter and prevent further passage of motion causing increased constipation. This condition if often seen in girls and young women. They usually get scared going to the toilet because of the fear of pain. A few drops of blood are seen at the end of passing motion and quite often a pile mass or a skin tag is seen at the anus. Drinking plenty of water, eating vegetables and fruits will make stools soft and pain lesser. Local anaesthetic ointments, sitz bath(warm water with savlon/Dettol) and laxatives help in a majority of patients. If pain doesn’t subside then a small surgery in the form of lateral sphincterotomy and gentle anal dilatation effectively gives a permanent cure to these patients. This is a day-surgery procedure.

Fistula In Ano

Fistula in ano denotes a small opening/openings by the side of the anus discharging blood mixed foul smelling pus staining the undergarments of the patient. Fistulae either result from a ruptured abscess or a surgically drained peri-anal abscess.

These fistulae become painful if the outer opening gets blocked. All these fistulae will have a communication with the rectum and hence do not spontaneously close. Some fistulae are superficial called low anal fistulae and some are quite deep called high anal fistulae. Some fistulae are multiple or branched. There is no medical treatment for fistula-in-ano. All the fistulae require surgical treatment and these are notorious for recurrence. A MR fistulogram will be necessary in complex fistulae before planning out surgery. Simple low anal fistulae can be cured by a simple surgery. Complex fistulae may require staged operations or multiple operations for a complete cure. Some of them require a seton suture. A new equipment called VAAFT (video-assisted) seems to be of promise in complex fistulae. Fistula surgery including VAAFT can be done on a day-surgery basis.

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