An anal fissure is a small tear or cut in the skin that lines the anus. Fissures are quite common in female.

The typical symptoms of an anal fissure are pain and bleeding during or after defecation. Patient tries to avoid defe cation due to excruciating pain. A hard, dry bowel movement is typically responsible for a fissure. Other causes of a fissure include diarrhea or inflammatory conditions of the anal area. Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). Chronic fissures often have a small external lump associated with the tear called a sentinel pile or skin tag.

An acute fissure is typically managed with non-operative treatments and over 90% will heal without surgery. A high fiber diet, fiber supplements, stool softeners, and plenty of fluids help relieve constipation and promote soft bowel movements, and aide in the healing process. Increased dietary fiber may also help to improve diarrhea. Warm baths for 10-20 minutes 2-3 times a day are soothing and promote relaxation of the anal muscles, which can also help healing. Occasionally, special medications may be recommended. A chronic fissure requires surgical treatment. Surgery is a highly effective treatment for a fissure and recurrence rates are very low after surgery.

Anal fissure require one day/day care surgery. Post operative care is explained at our center.

A patient feels ill and complains of chills, fever and pain in the anus, or sudden pain during defecation. It results from an acute infection of a small gland just inside the anus, if not treated it ruptures spontaneously. Leading to drainage of pus which often relieves the pain and fever and possibility of fistula increased. An anal fistula is almost always the result of a previous abscess. A fistula develops in about 50 percent of all abscess cases. . A fistula is a small tunnel that forms under the skin and connects a previously infected anal gland to the skin on the buttocks outside the anus.

Surgery is necessary to cure both anal abscess and fistula. Although abscess surgery is usually relatively straight forward but the potential for developing fistula exists. Although fistulas often develops four to six weeks after an abscess is drained, sometimes even months or years later but in few cases it can be treated simultaneously.

Fistula surgery usually involves opening up the fistula tunnel. Often this will require cutting a small portion of the anal sphincter, the muscle that helps to control bowel movements. . Treatment of a deep or extensive fistula requires surgical skills and long duration of treatment.

Hemorrhoids are one of the most common ailments known in anal area. More than half the population will develop hemorrhoids, usually after the age of 30.

Females suffer in silence for a long because they do not want to reveal it to surgeon as they are shy to show their private parts and scared of surgery. An exact cause of hemorrhoid is unknown; however, the upright posture of humans , Aging, Chronic constipation or diarrhea, Pregnancy, Straining during bowel movements,
Spending long periods of time (e.g., reading) on the toilet, Faulty bowel function due to overuse of laxatives or enemas last but not the least Heredity are a few of the reasons. Whatever the cause, the tissues supporting the anal vessels gets stretched. As a result, the vessels get dilated and their walls become thin and bleed. If the stretching and pressure continue, the weakened vessels protrude and bleed further. Most common symptoms of hemorrhoids include: Bleeding during bowel movements, Protrusion during bowel movement, Pain Sensitive lump(s)

There are two types of hemorrhoids according to location.

External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin. These are usually painless. However, if a blood clot (thrombosis) develops in an external hemorrhoid, it becomes a painful, hard lump. The external hemorrhoid may bleed if ruptures.

                         Piles                                                  Interno External Piles

Internal (inside) hemorrhoids develop within the anus beneath the lining. Painless bleeding and protrusion during bowel movements are the most common symptom. However, an internal hemorrhoid can cause severe pain if it is completely protrudes from the anal opening and cannot be pushed back inside.

Treatment methods make some types of hemorrhoid removal much less painful.

Mild symptoms can be treated frequently by increasing the amount of fiber (e.g., fruits, vegetables, breads and cereals) and fluids in the diet. Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevention from protruding. A sitz bath - sitting in plain warm water for about 10 minutes provide some relief.

With these measures, the pain and swelling of most symptomatic piles will decrease and the firm lump should recede within four to six weeks.

Hemorrhoids have many types of surgical options.

In case of thrombosed pile mass, removal of the clot with a small incision generally provides relief.

.  Ligation /Banding- the rubber band treatment - works effectively on internal hemorrhoids that protrude with bowel movements. A small rubber band is placed over the cutting off its blood supply. The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two. This procedure sometimes produces mild discomfort and bleeding and may need to be repeated for a full effect.
.  Injection and Coagulation can also be used on bleeding hemorrhoids that do not protrude. Both methods are relatively painless and cause the hemorrhoid to shrivel up..

.  Hemorrhoidectomy - surgery to remove the hemorrhoids is the most complete method for removal of internal and external hemorrhoids.

It is necessary when

(1) clots repeatedly form in external hemorrhoids;

(2) ligation fails to treat internal hemorrhoids;

(3) the protruding hemorrhoid cannot be reduced; or

(4) there is persistent bleeding.

A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion. It is done under anesthesia using either sutures or staplers .

 Hemorrhoid stapling - this is a technique that uses a special device to internally staple and excise internal hemorrhoid tissue. The stapling method may lead to shrinkage external hemorrhoids. This procedure is done under anesthesia .It is less painful than conventional hemorrhoidectomy chances of recurrence is very low but it is an expensive treatment due to the cost of stapler

Laser hemorrhoidectomy does not offer any advantage over standard operative techniques. They are also quite expensive, and contrary to popular belief, are no less painful.

In our clinic patients can discuss each aspect of surgery with our surgeon she will provide all detail of operative procedure and post operative care.

Rectal prolapse is a condition in which the rectum stretched out and protrudes out of the anus.It occurs due to weakness of the anal sphincter muscle , resulting in leakage of stool or mucus. While the condition occurs in both sexes, it is much more common in elderly women may be due to generalized pelvic floor dysfunction, chronic urinary incontinence and pelvic organ prolapse due to multiple pregnancies. In neurological problems such as spinal cord disease, lifelong habit of straining during defecation or fecal evacuation by finger are some other common causes.

Correcting bowel habits may not improve the prolapse once it has developed. There are many different ways to surgically correct rectal prolapse.

Simple wire around anus can be considered in thin built elderly patients.

Abdominal or rectal surgery may be suggested. An abdominal repair may be approached Laparoscopically in selected patients. The decision to recommend an abdominal or rectal surgery takes into account many factors, including age, physical condition, and extent of prolapse and the results of various tests.

Our surgeon examines the patient carefully and after detailed investigations she offers any treatment.

A rectocele is a bulge of the front wall of the rectum into the vagina. The rectal wall may become thinned and weak, and it may balloon out into the vagina during bowel movements. rectocele occur in women because of weakening of the pelvic support structures That may be due to multiple, difficult or prolonged deliveries, the use of forceps or other assisted methods of delivery, perineal tears, or an episiotomy into the rectum or anal sphincter muscles. In addition constipation and straining with bowel movements, or hysterectomy may contribute to the development of a rectocele..

Rectocele may bea part of a more generalized weakness of pelvic support and may exist along with a cystocele, urethrocele, and enterocele, or with uterine or vaginal prolapse, rectal prolapse, and fecal or urinary incontinence.

Symptoms may be primarily vaginal or rectal. Vaginal symptoms include vaginal bulging, the sensation of a mass in the vagina, pain with intercourse or even something hanging out of the vagina that may become irritated. Vaginal bleeding is occasionally seen. Rectal symptoms include constipation with difficult evacuation with straining. Often this is associated with bulging in the vagina when straining to have a bowel movement. Some women find that pressing against the lower back wall of the vagina or along the rim of the vagina helps to empty the rectum. At times, there will be a rapid return of the urge to have a bowel movement after leaving the bathroom because stool that was trapped in the rectocele may return to the low rectum after standing up. A general feeling of pelvic pressure or discomfort is often present but this may be due to a variety of problems.

Most rectoceles may be identified on a routine examination of the vagina and rectum. . rectocle that are not causing symptoms do not need to be treated. Avoid constipation and prolonged straining by eating a high fiber diet and drinking plenty of fluids.

If symptoms persist even with medical therapy, then surgical repair may be indicated. There are several surgical techniques used to repair a rectocele. A rectocele repair may be performed through the anus, through the vagina, through the perineum between the anus and vagina, or from above through the abdomen. When there is extensive pelvic relaxation and prolapse, the best approach may be a combined repair.

In our center team of gynecologist, surgeon and plastic surgeon give the best advice and treatment of the patient.

Venereal warts are sexually transmitted diseases that infect the anal and genital areas. They usually spread from person to person by sexual contact. They can also spread from inanimate objects, such as a shared bath towel. Approximately two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within three months of contact.
Condyloma are reddish pink to whitish moist growths that occur on the anus and genitalia as a result of infection with the papilloma virus, the most common viral sexually transmitted diseases (STD). In the anal area they may be mistaken for hemorrhoids.

Treatment is destruction of the wart tissue and allow for normal healing. This can be done by electrocautery, Cryotherapy , CO2 laser or chemical cautery. This is done as an out patient surgical facility. Immunotherapy is another option there is a commercial preparation of alpha interferon is available which is injected into the wart which stimulates an immune response causing the wart to disappear. It is a costly treatment.

Destruction of all warts the patient must still be carefully followed for the development of recurrence. At the time of surgery all visible warts are destroyed but it may take up to 30 days before infected tissue shows signs of wart development. It is therefore very important that prolonged follow-up be performed to assure cure.

Pilonidal Disease

Pilonidal disease is a chronic infection of the skin in the region of the buttock crease. The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks. The disease is more common in men than women and frequently occurs between puberty and age 40. It is also common in obese people and those with thick, stiff body hair.

Symptoms vary from a small dimple to a large painful mass .or an episode of an acute abscess. Often the area will drain fluid that may be clear, cloudy or bloody. With infection, the area becomes red, tender, and the drainage (pus) will have a foul odor. The infection may also cause fever, malaise, or nausea.

Surgery is almost always required to resolve this condition.

•  An acute abscess is managed with an incision and drained to release the pus, and reduce the inflammation and pain. Post operative dressings are required

         Pilonidal Disease                    Removed Pilonidal Sinus

•  Complex or recurrent disease must be treated as sinus excision and possible closure with flaps. It does not require regular dressings and stitches removed on eighth day.

If the wound is left open, it will require dressing or packing to keep it clean it may take several weeks to heal.

In our clinic surgeon will discuss all these options with you and help in selection of the appropriate operation. She will also look after the post operative management.

TUMORS

There are many types of tumors found in rectal, anal and perianal region. They can be benign or malignant. In this site we don't provide details but we also treat surgically whenever required.