Anal Diseases; the Anal region is the last part of the digestive system. Diseases are usually very painful. The most common 3 anal diseases which have similar symptoms are; haemorrhoid, perineal fistula and anal fissure.
The haemorrhoid is a disease caused by swelling of the veins around the anal area like varicose in the legs. Reasons are usually; standing on the foot for a long time, diarrhea, constipation, lack of movement, heart failure, liver cirrhosis, coughing and vomiting for a long. It is a very rare situation that there is no one who has not experienced haemorrhoid at any part of his/her life. Sometimes, it may not show symptoms. It is almost never seen in children. The most common symptom is bleeding. Pain, sense of burning, feeling of pressure, swelling, itching, constipation, discharge and piles are among other symptoms. Anal area diseases are diagnosed with the examination of the related region. If necessary, endoscopic examination (examination of anal region and large intestine by a tool) is performed. Since the symptoms are the same with cancer of this region, haemorrhoid treatment should not be applied. There are various treatment methods changing depending on each disease and period during which disease is diagnosed. Treatment is possible with medication and also sclerotherapy, band ligation and surgical treatment can be performed. It is determined by the doctor which of these treatment methods to be applied.
Anal fissure means the small crack-tear on the edge of the anus. It usually occurs as a result of hard and difficult defecation in the form of constipation. It is commonly seen in infants and women who have recently given birth. It causes bleeding and pain. Local anesthesia or spinal anesthesia is appropriate for the operation. General anesthesia is not required. The patient is laid in a prone position (proctological). Anal area is thoroughly examined again under anesthesia. Depth and length of crack are analyzed. 1 cm incision is done from the edge of the anus. The muscle structure (internal sphincter) which regulates the constriction of the anus during the resting time is isolated and partial relaxation incision is applied. In some patients, crest at the outer edge of crack (sentinel pile) is incised and corrected. The operation takes only a few minutes after anesthesia and other preliminary preparations are completed. The crack is not sutured in the operation. Relaxation is achieved in internal sphincter muscles by entering from another point. The aim of the operation is to eliminate spasm and circulatory problems in the wound area. Bleeding disappears within a week. Wounds disappear in a few weeks. Full recovery is above 95%.
The fistula is the inflammation canal which develops around the anus. This canal has one inner mouth and one outer mouth. The outer mouth can be easily observed on the skin around the anus. It is in the form of a pimple which has a hole in the middle. Inner mouth is placed on intestinal wall 2-3 cm inside the anus entrance. Sometimes it can be easily found during the examination but sometimes it may be difficult to find. Stained x-rays and MRI may be necessary for that reason. The hardness of inflammation canal is prominent between the inner mouth and the outer mouth like a cordon. Once fistula has occurred, it means that there will be inflammation all the time. It cannot be expected to recover spontaneously.
It is preferred if the inflammation canal of fistula is extended from the anal area to deep and far parts. That is because; the standard operation may more possibly disrupt the defecation control in such cases. Seton application allows the procedure of ‘elimination of canal’ – the same achieved by the operation – in an extended time. A thick indissoluble rope or similar material is passed through the canal and tied up in a way to create a ring around the anus on the outer part. This ring, called the seton, is gradually narrowed to tighten the tissue around anus at an interval of a few weeks and expected to be relieved by slowly progressing through the anus. While the seton congests the inflammation canal at a very slow pace in the direction of the anal orifice, it also allows repair of residue tissues at the same time. Thus, it is ensured that the canal is eliminated within weeks without causing permanent damage to defecation control.
The only treatment method for most of the anal fistulas is the operation. Spinal anesthesia is preferred for the operation and injection is done from the waist and lower part of the body is anesthetized. One night before the operation, the laxative syrup is given to the patient and intestines are discharged. Inner and outer mouths of the canal are explored in the operation. The guide wire is passed along the canal and the target is determined. Tissues are incised from the edge of anus until the canal at depth in a way to reveal the wire. This procedure is similar to opening the upper part of a hidden canal under the ground and giving it a valley shape. Sometimes, it is preferred to cave the wall of the canal. These procedures are called as fistulotomy, fistula tract excision in the medical literature. In this way, a slit is formed around the anus in a few centimetres’ lengths. The patient may leave the hospital on the same day, if necessary, it is sufficient to stay at the hospital for one night.