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Thursday, February 21, 2008

Anorectal Disease

In conjunction with the Women's Center for Pelvic Disorders, the physicians in this group evaluate and treat patients with pelvic floor disorders, constipation and fecal incontinence. Patients have access to new techniques and therapies for fecal incontinence, hemorrhoids, fissures and anal fistulas among other anorectal diseases. To achieve a comprehensive diagnosis, the department utilizes specialized equipment, including ultrasound, to visualize the anal muscles, as well as a dedicated laboratory to evaluate stool incontinence.

All of the surgeons in the Department of Colorectal Surgery have extensive training and experience in the management of anorectal disease. The typical symptoms of patients suffering from anorectal disease include: bleeding, pain, discharge and itch (or pruritus).

Descriptions of the conditions commonly seen by specialists in anorectal disease are below.

Hemorrhoids - A normal part of the anal anatomy, which helps control bowel motions and gas. When enlarged they may cause discomfort or bleeding and need assessment. Treatment is usually performed in the office with either dietary instructions or application of local hemorrhoid treatments which can be performed at the time of the initial office visit. Larger hemorrhoids may require an operation and, if so, an admission for a day case surgical procedure is arranged.

Anal fissure - Patients have severe pain and sometimes bleeding after passing a bowel motion. Generally, medical treatments can be prescribed in the office. For cases which do not respond to this, a minor surgical procedure can be performed in the office under local anesthetic.

Pilonidal Disease - Patients may develop abscesses between the buttocks, which can be treated in the office and, in rare cases, a general anesthetic required. Definitive later therapy may require a general anesthetic and subsequent wound care.

Anorectal sepsis and fistula - Patients may have severe pain and swelling caused by an abscess in the anal region. The usual initial treatment involves insertion of a small plastic drain under local anesthetic in the office. This gives almost instantaneous relief of symptoms. Some patients with an abscess will later develop a fistula, which requires further treatment. Patients who require further treatment, or patients who have a fistula at their initial visit may require surgery under general anesthetic, which is often arranged at the initial outpatient visit. These fistulas, or abnormal tracts connecting the anal canal or rectum to skin around the anus, sometimes require more than one treatment to heal completely.

Sexually transmitted diseases - Some patients with anal infections may develop pain and/or bleeding. These are treated in the office, sometimes in consultation with the Infectious Disease Department. Some patients may have warts in the anal region, which can usually be treated in the office under local anesthetic.

Malignant tumors - In rare cases, patients develop a swelling or mass in the anal area which is caused by a cancer. Surgeons in this department are experienced at defining the treatment regimes for such tumors which may involve chemotherapy or radiation prior to surgery, or simply proceed with the surgery if needed. The treatment plan is based on individual patient assessment.

Other conditions - Patients may have problems related to the skin around the anus, which can be treated in the office. Patients with discomfort or itch in the anal area can be treated with dietary advice and other suggestions.

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