Piles, fissure and fistula, perianal abscesses are the main diseases affecting the majority of the population. These diseases are increasingly seen in people nowadays due to faulty diet habits such as junk food, fast food, spicy diet.
Piles
Piles are swollen engorged blood vessels in the lower part of the anal canal which may bleed profusely with or without pain. Sometimes they may produce a deficiency of haemoglobin ( anemia). They are produced due to continuous pressure of loaded stool on the rectum, excessive straining and also due to weak valves in blood vessels in this area. They are diagnosed on proctoscopy and graded from 1 to 4.
There are different treatment options for different grades of piles. Multiple treatment options for piles include-
- Sclerotherapy: A sclerosant injection is injected into pile mass which shrinks the piles and stops bleeding.
- Rubber band ligtion: A small rubber band is applied at base of pile mass with the help of specialized instrument which occludes blood supply to pile mass and causes shrinkage of pile mass.
- Haemorrhoidectomy: Done in larger piles. Pile mass is completely excised and sutures are placed at its base. It is less expensive procedure.
- Stapler Haemorrhoidectomy: With the help of a special stapler device pile mass is excised completely. But this is an expensive procedure due to the cost of the stapler.
- Laser Ablation: Pile mass is ablated with the help of laser beam. Here pile mass is not excised but shrinkage and fibrosis is achieved with laser energy. It is also an expensive procedure.
Fissure
Fissure is a tear or ulcer that occurs in the lower part of the anal canal due to hard stool. Fissure is very painful and bleeding also occurs in this condition.
Fissure is of two types –
- Acute( recent): It is of short duration and heals if proper treatment and dietary changes are made not requiring surgery.
- Chronic: If the acute fissure is not treated well and if dietary changes are not made turns into a chronic fissure where the patient needs surgery.
What are surgical options in fissure?
- Anal dilatation
- Lateral anal sphincterotomy
- Fissurectomy - Done with sphincterotomy
What dietary changes should be done in fissure and piles?
- Eat high fibre diet, Drink plenty of fluids between meals, Don't strain at stool. Avoid junk and fast food.
Fistula
An infected tunnel between the skin and the anus.
An anal fistula is an infected tunnel between the skin and the anus, the muscular opening at the end of the digestive tract. Most anal fistulas are the result of an infection in an anal gland that spreads to the skin.
What are treatment options for fistula?
There is no medicinal treatment for fistula and it requires surgery only. Different surgeries are
- Fistulotomy : fistula tract is laid open by taking incision along its length.
- Fistulectomy : Fistula tract is completely removed surgically and defect (wound) is allowed to heal with natural course.
- Laser Surgery : Fistula tract is ablated( burned) with laser radial fibre.
- LIFT : Ligation of intersphincteric fistula tract- Done for high level fistula.
- VAAFT : Video assisted anal fistula treatment.
- DLPL : Distal laser proximal ligation treatment.
Perianal abscess- Abscess is an infection with pus formation it requires surgery where in incision and drainage surgery is done to remove the pus.