Piles, Fissures and Fistula Surgery
Piles are also called haemorrhoids which are masses, clumps, cushions of tissue in the anal canal. They are full of blood vessels, support tissue, muscle and elastic fibers and are classified into two general categories: internal and external.
Piles may develop due to chronic constipation, which leads to excessive straining resulting in swelling of the veins in the rectal area.
Physical examination and proctoscopy aid in the diagnosis of piles.
The treatment options available are as follows:
- Depending on the diagnosis, the surgeon ascertains if home treatment is all that is needed or further intervention is required. Lifestyle and dietary modifications such as regular physical exercise, plenty of fluids and a high fibre diet provide symptomatic relief.
- Surgery is used for particularly large piles. Generally, surgery is used when conservative treatment/management is not effective.
- Injection Sclerotherapy – The pile masses are injec ed with a sclerosing agent which causes them to shrin This method is successful in early cases of piles.
- Banding – This involves placing a band like noose at the root of the pile mass which gradually falls off as its blood supply gets cut off.
- Infrared Coagulation – This procedure only works in the early cases of piles. The base of the haemorrhoid is burnt with a very short exposure to infrared rays with the help of a probe.
- Haemorrhoidectomy (open surgery of the piles) – The excess tissue that is causing the bleeding is surgically removed. This can be done in various ways. It may involve a combination of a local anaesthetic and sedation, a spinal or general anaesthetic. This type of surgery is effective in completely removing piles, but is associated with pain for few days.
- Minimally Invasive Procedure for Haemorrhoids (MIPH) – This procedure is performed using a special circular stapler. It is relatively painless and be done as a day care surgery.
Anal fistula, or fistula-in-anot is a common anorectal problem in which an abnormal connection develops between the inner surface of the anal canal and the skin around the anal verge thereby causing severe pain and infection.
The symptoms of Anal Fistula are:
- Pain
- Bloody or purulent discharge
- Itching
- Systemic symptoms if abscess becomes infected
The best and most effective way to treat Anal Fistula is surgery. Minimally Invasive Anal Fistula Treatment technique is a major breakthrough treatment option for complex fistulas.
In this technique, the fistula path is first examined with an endoscope to determine the point of the internal opening of the fistula. Then the internal opening of the fistula is closed with the help of stapler and the entire path of the fistula is destroyed by electrocautery under direct telescopic vision.
There is no surgical wound in the perianal region hence no dressings needed. The risk of faecal Incontinence is negligent because no sphinter damages occur. The procedure is done under spinal anesthesia/ general anesthesia. There is minimal post-operative discomfort thereby reducing the time of recovery.
An anal fissure is a small split or cut in the skin at the anal opening. Fissures typically cause pain and often bleed. Fissures are quite common, but are often confused with other causes of pain and bleeding, such as Most fissures occur along the mid-line – the top or bottom – of the anus.
The symptoms of anal fissure are following:
- Painful bowel movement
- Bleeding
- Constipation
Most anal fissures heal their own and do not need any specific treatment. However following treatment options are used to treat anal fissures:
- Drinking more fluids
- Eating a high-fiber diet to avoid constipation
- Using stool softeners
- Allowing enough time for a bowel movement
- Sitz baths (soaking anal area in plain warm water)
- Avoid foods that may not be well-digested (i.e., nuts, popcorn, tortilla chips)
- Topical ointments
- Surgery: Lateral Sphincterotomy (For patients not responding to medical treatment)