Haemorrhoids - Haemorrhoidal disease

What are haemorrhoids

Haemorrhoids are vascular cushions that are normally present in the anal canal in all people and contribute to the mechanism of continence and control of bowel movements. They become a medical condition when they enlarge/swell and cause symptoms. Haemorrhoids are not dangerous; however, when symptomatic, they may significantly affect a patient’s quality of life.

Symptoms

• Bright red blood during bowel movements (in the toilet or on toilet paper)
• Itching or burning sensation on the area of the anus
• Prolapse (haemorrhoids protruding outside the anus during bowel movements)
• Pain is not a typical symptom of haemorrhoids. It usually occurs when a blood clot forms (thrombosed haemorrhoid) or when inflammation develops.

Diagnosis

Diagnosis is made through clinical examination and proctoscopy (examination of the anal canal using a small specialised instrument).

Treatment

Treatment of haemorrhoidal disease is individualised for each patient, depending on the grade of haemorrhoids, the symptoms they cause and the patient’s preferences. Conservative treatment is the first step in the management and can provide symptomatic relief in many cases. When conservative treatment fails, with persistent symptoms or frequent recurrences and in cases of advanced-stage haemorrhoids, surgical intervention is the definitive treatment of the haemorrhoidal disease. The choice of surgical treatment method is personalised after careful assessment and discussion with each patient.

Anal Fissure

What is an anal fissure

An anal fissure is a small tear/wound in the skin of the anal canal. It is a very painful condition and often develops following constipation or episodes of diarrhoea.

Symptoms

The typical symptom of an anal fissure is severe pain during and after bowel movements, which may last from several minutes to several hours. A small amount of bright red blood may also be noticed on toilet paper.

Diagnosis

Diagnosis is made through clinical examination, usually by simple visual inspection of the anal area.

Treatment

First-line treatment for an acute anal fissure is conservative management, including regulation of bowel movements and the local application of specific ointments that help relax the anal sphincter.

Surgical treatment is recommended when the fissure becomes chronic (lasting more than 6–8 weeks) and does not respond to conservative treatment.

Perianal abscess

What is a perianal abscess

A perianal abscess is a collection of pus in the area around the anus or rectum. It may be located just beneath the skin or deeper within the surrounding tissues. It is usually caused by blockage and subsequent infection of small glands that are normally present inside the anal canal.

Symptoms

• Severe, constant pain around the anus, which worsens when sitting or during bowel movements
• Swelling, redness and tenderness in the affected area
• Fever and general feeling of unwellness in more serious cases
• Possible discharge of pus if the abscess has already ruptured spontaneously

Diagnosis

Diagnosis is mainly made through clinical examination. In some cases, especially when a more complex or extensive abscess is suspected, imaging such as Ultrasound examination or MRI of the pelvis may be required, to help accurately identify the location and extent of the abscess.

Treatment

The treatment of a perianal abscess is surgical and involves the incision of the abscess, the drainage of the pus and the surgical cleaning of the infected cavity. Depending on the size and extent of the abscess, the procedure may be performed under local or general anaesthesia. Antibiotic treatment may be recommended as an additional measure in patients with extensive abscesses or in those with underlying medical conditions.