ANAL SURGERY AND TREATMENTS

Haemorrhoids

Haemorrhoids are engorged vascular anal cushions that can cause a number of symptoms including bleeding. These are discussed in detail under conditions.

Various creams are available but if you are still suffering there are a variety of non-surgical and surgical options that Mr Stellakis can perform to help you. The more effective the treatment usually the more recovery is needed.

These treatments are performed either in clinic or in the endoscopy unit. They require no sedation although banding can be little painful for a few hours after the procedure. Injection sclerotherapy is completely painless but not such a good treatment in men.

If these so called ‘office procedures’ fail to treat the haemorrhoid, they can be repeated a few times to improve results. If these however do not work or the haemorrhoids are particularly advanced, there there are a number of surgical options.

‘Office procedures’

  • rubber band ligation – a band is placed around the pile causing it to drop off
  • injection sclerotherapy – a chemical agent is injected into the pile to make them shrink

These are very well tolerated with very few if any risks and can be done in the clinic setting. Banding can be a bit uncomfortable for a few hours and rarely for a day or two. Injection sclerotherapy is completely painless but not such a good option for men.

Haemorrhoidectomy

These include:

  • haemorrhoidectomy – the pile is cut out along with any skin tags.
  • stapled haemorrhoidopexy – the pile is stapled back inside the anus
  • haemorrhoidal artery ligation – stitches are used to cut the blood supply to your piles to make them shrink

These procedures are performed under a general anaesthetic but usually as day cases. Mr Michael Stellakis will recommend the suitable treatment and discuss the benefits and potential risks at your consultation.

Please refer to information sheets below.

Anal fissures and tears

Anal fissures and tears are a common problem and are often caused by constipation or straining during bowel movements. they are discussed in ore detail under conditions hypertext.

The first step in treating anal fissures and tears include lifestyle changes such as adopting a high fibre diet or using fibre supplements to help soften bowel movements. Drinking more fluids can help prevent hard stools and aid in healing.

Creams

If this does not work then taking stool softeners can help and these are often prescribed in conjunction with a cream to help relax the sphincter. There are two examples. The first is GTN cream (Rectogesic) which works fairly well at healing the tissue but often causes severe headaches on application. People sometimes prefer the anal pain the headache! The other more effective but unfortunately more expensive cream is Diltiazem 2% cream (Anoheal). Generally these creams are used for 6 weeks and if the fissure is still painful at this point treatment needs to be escalated.

Botox

Although most anal fissures and tears do not require surgery some do and the safest most effective treatment is injecting Botox into the sphincter to help it relax. This is performed by Mr Stellakis under a quick general anaesthetic although some units do it in the clinic setting without anaesthetic. This treatment is 80% effective in treating the fissure first time but can be repeated several times. There are some rare potential side effects that Mr Stellakis will discuss with you but they are temporary.

Sphincterotomy

It is rare these days that surgeons resort to invasive surgery but sometimes  minor plastic surgery to cover the fissure is needed together with division of the internal sphincter muscle. Again, this is done under a general anaesthetic.

Anal fistula

Although anal fistulae are not a serious or life threatening  condition their management is often difficult and complex. Treatment generally falls into two categories.

Seton insertion

The problem with fistulae is that the body tries to heal the tract and in so doing creates a problem. If the tract partially heals there is no place for the infection that inevitably builds up to go and and an abscess forms. This then bursts and the cycle repeats. In most cases, therefore,  the first stage of treatment is to drain any infection and prevent further cycles of anal infection and potential abscess formation.

Counterintuitively, keeping the fistula open with a small drainage band called a seton is often the first line of treatment. This is placed through the fistula whilst under a general anaesthetic after a full examination of the anal canal and and rectum. Mr Stellakis will explain in more detail what this entails but it is generally well tolerated. Once any infection has cleared, which usually takes about three months, a more definitive operation is carried out to get rid of the fistula completely and dispense with he need to have the seton.

Definitive treatment

Obviously the perfect goal would be to remove the fistula completely and therefore dispense with the need for a seton. The best way is to lay the fistula open (fistulotomy).

This entails cutting through the fistula whilst under a general anaesthetic. It works extremely well but is not always possible to do safely.  The problem occurs  if the fistula goes through too much anal sphincter muscle. Laying open these ‘higher’ fistulae would damage the anal sphincter too much and potentially render the patient incontinent. This is obviously not acceptable.

Over the years a number of alternative operations have been developed to get round this problem. The idea is to remove the fistula without damaging the sphincter. Mr Stellakis will explain what these different procedures entail.