colonandrectalspecialists

Treatment of Anal Warts

What are anal warts?

Anal warts (also called “condyloma acuminata”) are skin eruptions that affect the area around and inside the anus and even the genitak area.Usually, they do not cause painor discomfort to afflicte individuals and patients may be unaware that the warts are present. Some patients will experience symptoms such as itching, bleeding, discharge and/or a feeling of a lump or mass in the anal area.

What causes these anal warts? Anal warts are thought to be caused by the human papilloma virus (HPV), which is transmitted from person to person by direct contact.HPV is considered a sexually transmitteddisease. You do not have to have anal intercourse to develop anal condyloma.

Do these need to be warts always removed

Yes. If they are not removed, the warts usually grow larger and multiply, and may even lead to an increased risk of cancer in the affected area. In addition,warts are contagious and can affect the partner of the infected patient if left untreated.

What treatment options

Topical medication – for small and superficial warts; sometimes for warts inside the canal. 

Surgical removal – for bigger and recurrent warts; provides immediate result and can be done on out-patient basis but usually under anesthesia.

How much time will I lose from work after surgical treatment?It varies from just 1 day to several days depending on the extent of the disease and post-treatment pain.Will a single treatment cure the problem?

Because HPV can live concealed in tissues that appear normal for several months before another wart develops, recurrent wartsare common. Return visits to the physician’s office may be necessary as new warts develop.

How long is treatment usually continued Frequent follow-up visits with your specialist for several months after the last wart is observed are necessary to be certain that no new warts occur.

Simple, Complex and Recurrent Fistula In Ano

Fecal Incontinence and Constipation

Acute and Chronic Anal Pain

What is an anal abscess? anal fistula?

An anal abscess is an infected cavity filled with pus found near the anus or rectum. Small glands just inside the anus may get clogged (usually, by feces) and become infected, thus leading to abscess formation.

An anal fistula is an abnormal connection or a small tunnel that forms under the skin connecting a previously infected anal gland to the skin of the buttocks, and is almost always (90% of cases) the result of a previous abscess.

Anal Abscess

A patient complaining of chills, fever, and pain in the anus may be suffering from an anal abscess (pigsa sa puwit). Often,there may be purulent discharge (nana) observed especially if the abscess has ruptured. This may later form an anal fistula.

What are the symptoms of an abscess and fistula?

Abscess

• Pain and tenderness, erythema (redness), and swelling around the anus.

• Fatigue, fevers and chills.Fistula

• Irritation of skin around the anus.

• On and off drainage of pus (which often relieves the pain).

• Staining of underwear.

• Fever and generalized weakness.

Treatment

Abscess drainage is the most important part of abscess management.In the presence of an anal fistula, surgery becomes the only treatment option.

• Fistulotomy usually involves opening up the fistula tunnel and converting it to a groove that will allow it to heal from the

inside out. The procedure, however, is not expected to significantly affect the patient’s capability to control bowel movements, particularly when done by a colorectal specialist.

• Other surgical options such as Seton application, ligation of intersphincteric fistula tract (LIFT), mucosal and anocutaneous advancement flaps, anal fistula plug, and fibrin glue application are best discussed with a colorectal specialist.

Recovery

Home care includes intake of pain medication for post-operative discomfort, warm sitz bath (soaking the affected area in warm water) three or four times a day and stool softeners or a bulk fiber laxative. The amount of time lost from work or school is usually minimal. Bowel movements will not affect healing, although it may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes

Recurrence

If properly healed, an abscess or fistula will usually not return. However, if the outside opening of the tunnel heals, recurrent abscess may develop. Persistent drainage from the skin opening may indicate the persistence of the fistula. A recurrent (repeating) fistula will be less likely to improve immediately; thus, it is best to consult a colorectal specialist at the outset and to carefully follow care instructions to prevent recurrence.

Hemorrhoids and Fissures


What are hemorrhoids HEMORRHOIDS, what are they?

Hemorrhoids are blood vessels in the anal area serving as cushions during bowel movement. Internal hemorrhoids are located inside the anus while external hemorrhoids are located outside. 

What are the types of internal hemorrhoids?

First degree hemorrhoids.Hemorrhoids that bleed but do not come out during passage of bowel movement.

Second degree hemorrhoids. Hemorrhoids that occasionally bleed and come out during bowel movement but go back in.

Third degree hemorrhoids.Hemorrhoids that occasionally bleed and come out during bowel movement but can be pushed back in manually.

Fourth degree hemorrhoids. Hemorrhoids that are pushedoutside and can not be pushed back in manually anymore.

What does hemorrhoids a person with experience?

There is usually bleeding of bright red blood dripping into the toilet bowl during bowel movement. Often, a mass or fleshy tissue comes out during straining.

What are the different types of treatment for hemorrhoids?

Medical management: for first and second degree internal hemorrhoids.

Rubber band ligation: for bleeding first and second degree internal hemorrhoids. This involves application of an elastic band at the base of the internal hemorrhoid.

• A high fiber diet that includes fruits and leafy vegetables.

• Adequate fluid intake.

• Avoidance of straining in the bathroom

Surgery: for persistent symptoms of bleeding, fleshy mass coming out, and problems with hygiene; unresponsiveness to medical management; or third or fourth degree or mixed (internal and external component) hemorrhoids.

• Hemorrhoidectomy: for third and fourth degree internal hemorrhoids. This is the traditional method of removing hemorrhoids. It makes use of a knife, scissors and other devices such as ligasure or harmonic scalpel.

• Stapled hemorrhoidopexy makes use of a surgical stapler to remove hemorrhoids and is associated with minimal post operative pain.

• Transarterial hemorrhoidal dearterialization: for second and third degree internal hemorrhoids. This method makes use of  Doppler ultrasound to detect arteries which are then ligated. This method is also is associated with minimal post-operative pain.

Examination for Common Anorectal Conditions

Common anorectal conditions are usually examined using digital rectal exam. A doctor  inserts a lubricated, gloved finger into the rectum to feel for abnormal lumps or areas. Then, a lubricated instrument (anoscope) is placed a few inches into the rectum. This is to view the anus, anal canal, and lower rectum.

 

Sexually Transmitted Anorectal Disease Examination

Diagnosis for sexually transmitted anorectal diseases has become more difficult in recent years owing to the complexity of  pathogens. Diagnosis and treatment has become even more challenging in the HIV+ patient population. Some common sexually transmitted anorectal infections are gonorrhea, chlamydia, syphilis, herpes simplex virus, and cytomegalovirus.

The specialist usually begins with a thorough history of the patient. This is accompanied by a focused physical examination. Laboratory studies (serological, bacteriological or pathological with tissue biopsy and examination) confirm the diagnosis.

 Proctosigmoidoscopy / Flexible Sigmoidoscopy

A sigmoidoscopy is an examination that allows the doctor to look inside the rectum and lower (sigmoid) colon for polyps using a narrow, lighted tube called a sigmoidoscope. If any polyps are found during the exam, they can be removed in a procedure called a polypectomy. A sigmoidoscopy is recommended every three to five years.

Endorectal and Endoanal Ultrasonography (UTZ)

Endorectal Ultrasound is a special ultrasound technique in which a transducer is directly inserted through the anus and into the patient's rectum. The sound wave echoes detected by the transducer are converted by a computer into an image. It is one of the most useful diagnostic tools for diseases of the anal and rectal regions of the body, especially for cancer screening and staging.

Diagnostic and Therapeutic Colonoscopy with Multi-band Intensity

A colonoscopy is an internal examination of the colon (large intestine) and rectum, using a long, flexible, tubular instrument called a colonoscope.

The colonoscope has a small camera attached to a flexible tube.  Unlike sigmoidoscopy, which can only reach the lower third of the colon, colonoscopy examines the entire length of the colon.

The patient will lie on his left side with knees  drawn up toward the chest.  After administering a sedative and pain reliever, the colonoscope is inserted through the anus. It is gently moved into the beginning of the large bowel and sometimes into the lowest part of the small intestine. Air will be inserted through the scope to provide a better view. Suction may be used to remove fluid or stool. Tissue samples may be taken with tiny biopsy forceps inserted through the scope. Polyps may be removed with electrocautery snares, and photographs may be taken.