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Perianal

Anal Fissures

Anal fissures are cracks and tears that develop in the lining of the anus and can be either acute or chronic. The crack exposes the muscle tissues and cause severe sharp pain and bleeding during passing of stool. Anal fissures usually develop in patients who have constipation and strain a lot while passing stools. They can also develop in patients who pass stools too frequently such as during an episode of diarrhea. They are also common during pregnancy.

Symptoms :

  • Severe pain in the anus while passing stools.
  • Blood in the stools, usually separate from the stools.
  • Severe burning and itching in the affected area
  • Constipation

Diagnosis
Physical Examination of the anorectal region by the doctor
Digital Rectal Examination by using proctoscope to find the severity of the tear and to exclude other possible causes of pain.

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Treatment

Diagram-of-the-Rectum

Usually anal fissures can be treated with help of lifestyle changes and non surgical treatments but in case the fissures are severe, then surgery is an only option to help reduce the pain
Non Surgical Treatments

  • Increase intake of fibre rich foods
  • Using stool softeners
  • Sitz (warm) bath to relax anal muscles and increase blood flow to the region
  • Using nitro-glycerine ointments to increase blood flow
  • Using pain killers to ease discomfort

Surgical Treatments

Botox Injections : This is used to paralyse the anal sphincter muscles thereby preventing spasms. This allows anal fissures to heal naturally.

Anal sphincterotomy :  it involves making a small cut in the anal sphincter muscles to relax them and thereby assisting in healing of the fissures.

Anal Fistula

Is an infected tunnel that can develop near skin around the anus. It usually appears as a hole near the anus. An anal fistula causes severe pain as well as bleeding and discharge. Most fistulas result from perianal abscess, which is a collection of pus, that has not been treated properly. Crohn’s disease is also an important cause of a chronic anal fistula that does not heal.

“Anal fistula is a serious ailment, which can only be cured through surgery.”

Symptoms : 

  • Irritation of skin around the anus and tenderness of skin
  • Constant and throbbing pain around the anus
  • Blood discharge during bowel movement
  • Pus and blood staining in the undergarments.

Treatment :
Most anal fistulas require surgery for complete treatment, because fistulas do not heal themselves. The type of surgery required depends on the position and complexity of fistulas. The aim of surgery is to heal fistulas without damaging the sphincter muscles. Various types of surgical treatments available are:

Fistulotomy :  This procedure involves cutting open the whole length of the fistula and then removal of the contents to flatten it out. After a couple of months, the fistula will reduce into a scar.

Seton Techniques : A piece of thread called Seton, is left inside the fistula to keep it open for a period of time so that it’s completely draining. Usually done for complex fistulas that cannot be completely removed.

Fibrin Glue : Fibrin Glue is injected into the fistula to seal the tract and is then stitched closed. It is not suitable for all fistulas.

Bioprosthetic Plugs : they are cone shaped plugs developed from human tissues. They are used to block the internal opening of the fistula and then stitched in place, where after tissues grow around them.

“Our Surgeons are experts in the treatment of anal fistulas in Dubai and have a vast experience with all the latest techniques including laser treatment.”

Pilonidal sinus

It is a blind tract which generally occurs in the cleft near the top of buttocks. It commonly contains hairs, debris and dirt. If it gets infected, it gives out a foul smell and oozes pus and blood. It is mostly found in young men or people whose jobs involve prolonged sitting. It is a very common condition and is notoriously recurring.

Causes : Exact cause of Pilonidal sinus are unknown but they are generally caused by

  • Hormonal changes
  • Prolonged sitting
  • Friction from clothes
  • Obesity
  • Having large amount of body hair

Once hair fragments get stuck in the skin they cause irritation and inflammation. As inflamed skin has a tendency to get infected easily, there is persistent infection in the affected area leading to development of the Pilonidal sinus and often contains dirt, debris and pieces of hair.

Symptoms

Initially, there won’t be any symptoms but just a small nodule noticeable near the buttocks. But as the infection progresses, symptoms become more visible and are commonly are :

  • Pain while standing or sitting
  • Soreness and swelling in the skin
  • Pus discharge with foul odour
  • Swelling in between the buttocks

Treatment

Usually if the infection is in early stages, it can be managed by maintaining good hygiene and keeping the buttock area clean and dry. Any hair should be immediately removed from near the sinus.

If pilonidal sinus becomes infected, it requires immediate medical attention to help the patient. Treatments suggested by our experts include :

Lancing : In this procedure, doctors use a scalpel to cut open the sinus, and remove all pus, hair and blood from the wound, which is then packed with sterile dressing to allow healing

Phenol Injection : Phenol, a chemical compound, is injected into the sinus. It acts as an antibiotic and if repeated over a period of time causes the lesion to harden and close.

Surgery : In case the infection is severe and causes the Pilonidal Sinus to recur again and again, surgery is the only option. Lesions are opened surgically, and then all the pus and debris is removed.

Laser Treatment : More recently, laser treatment has emerged as a successful solution for Pilonidal Sinus. It is a minimally invasive treatment with short recovery time. In this technique, first a small cut is made on the skin and all the pus is drained out. The entire sinus tract is then sealed using laser. Chances of recurrence are very low after Laser Surgery.