Anal Disorders

Hemorrhoids

Hemorrhoids are swollen blood vessels that line the anal opening caused by chronic excess pressure from straining during a bowel movement, persistent diarrhea, or pregnancy. There are two types of hemorrhoids: internal and external.

Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.

Symptoms

Symptoms of hemorrhoids include:

  • Anal itching
  • Anal ache or pain, especially while sitting
  • Bright red blood on toilet tissue, stool, or in the toilet bowl
  • Pain during bowel movements
  • One or more hard tender lumps near the anus

Exams and Tests

A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:

  • Stool guaiac (shows the presence of blood)
  • Sigmoidoscopy
  • Anoscopy

Treatment

Over-the-counter corticosteroid creams can reduce pain and swelling. Hemorrhoid creams with lidocaine can reduce pain. Witch hazel should not be used as it can dry the area and worsen symptoms. Other steps for anal itching include:

  • Wear cotton undergarments.
  • Avoid toilet tissue with perfumes or colors.
  • Try not to scratch the area.

Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.

For cases that don't respond to home treatments, a gastroenterologist can place small rubber bands over the hemorrhoids to help shrink them.  This may help avoid surgery.

Outlook (Prognosis)

Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.

Prevention

Avoid straining during bowel movements. You can help prevent hemorrhoids by preventing constipation. Drink plenty of fluids, at least eight glasses per day. Eat a high-fiber diet of fruits, vegetables, whole grains. Consider fiber supplements.

Internal hemorrhoids

Internal hemorrhoids are normal structures cushioning the lower rectum and protecting it from damage by stool. When they fall down into the anus as a result of straining, they become irritated and start to bleed. Ultimately, internal hemorrhoids can fall down enough to prolapse (sink or protrude) out of the anus.

Treatment includes improving bowel habits (such as avoiding constipation, not straining during bowel movements, and moving your bowels when you have the urge), using elastic bands to pull the internal hemorrhoids back into the rectum, or removing them surgically. Surgery is needed only for a small number patients with very large, painful, and persistent hemorrhoids.

External hemorrhoids

External hemorrhoids are veins that lie just under the skin on the outside of the anus. Sometimes, after straining, the external hemorrhoidal veins burst and a blood clot forms under the skin. This very painful condition is called a pile.

Treatment includes removing the clot and vein under local anesthesia in the doctor’s office.

Anal fissures

Anal fissures are splits or cracks in the lining of the anal opening. The most common cause of an anal fissure is the passage of very hard or watery stools. The crack in the anal lining exposes the underlying muscles that control the passage of stool through the anus and out of the body. An anal fissure is one of the most painful problems because the exposed muscles become irritated from exposure to stool or air, and leads to intense burning pain, bleeding, or spasm after bowel movements.

Treatment

Most fissures heal on their own and do not require treatment, aside from good diaper hygiene in babies.

However, some fissures may require treatment. The following home care methods usually heal most anal fissures.

Initial treatment for anal fissures includes pain medicine, dietary fiber to reduce the occurrence of large, bulky stools, and sitz baths (sitting in a few inches of warm water). If these treatments don't relieve pain, surgery might be needed to decrease spasm in the sphincter muscle.

  • Cleansing more gently
  • Diet changes -- eating more bulk, substances that absorb water while in the intestinal tract
  • Muscle relaxants applied to the skin
  • Numbing cream, if pain interferes with normal bowel movement
  • Petroleum jelly applied to the area
  • Sitz bath
  • Stool softeners

If the anal fissues do not go away with home care methods, treatment may involve:

  • Botox injections into muscle in the anus (anal sphincter)
  • Minor surgery to relax the anal muscle

Outlook (Prognosis)

Anal fissures generally heal quickly without further problems. However, people who develop fissures are more likely to have them in the future.

Prevention

To prevent anal fissures in infants, be sure to change diapers frequently.

To prevent fissures at any age:

  • Keep the anal area dry
  • Wipe with soft materials or a moistened cloth or cotton pad
  • Promptly treat any constipation or diarrhea
  • Avoid irritating the rectum

Perianal abscesses

Perianal abscesses can occur when the tiny anal glands that open on the inside of the anus become blocked, and the bacteria always present in these glands cause an infection. When pus develops, an abscess forms. Treatment includes draining the abscess, usually under local anesthesia in the doctor's office.

Anal fistula

An anal fistula often follows drainage of an abscess and is an abnormal tube-like passageway from the anal canal to a hole in the skin near the opening of the anus. Body wastes traveling through the anal canal are diverted through this tiny channel and out through the skin, causing itching and irritation. Fistulas also cause drainage, pain, and bleeding. They rarely heal by themselves and usually need surgery to drain the abscess and "close off" the fistula.

Conditions We Treat