:: HITECH SURGERY :: - Piles, Fissure, Fistula, Pilonidal Sinus Surgery

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Piles, Fissure, Fistula, Pilonidal Sinus Surgery

Warning: As the symptoms of anal pain, bleeding/ blood staining, swelling are common to various anal problems like hemorrhoids (piles), anal fissure, abscess, fistula, anal and rectal cancer, proper examination by a surgeon is important. One should not presume that the problem is piles and ignore it or keep trying home or alternative remedies.

What are hemorrhoids (piles)? Can they be prevented?

The usual causes of hemorrhoids (piles) are genetic predisposition to weak vein walls and valves (Varicose veins) and straining during bowel movements. Other causes include pregnancy, portal hypertension and rectal cancer. Obesity, a sedentary lifestyle and sitting for prolonged periods of time also contributes to its formation.

Prevention of hemorrhoids includes drinking more fluids, eating a high fiber diet (fruits and vegetables, and whole unpolished cereals high in fiber), exercising, practicing better posture, and avoiding prolonged straining to pass stools. Laxatives should be avoided. Use of squat toilets relaxes the pelvic muscles and reduces straining to pass stools.

What are the non surgical treatment options for hemorrhoids (piles)?

A high fiber diet (or fiber supplement) and plenty of fluids to keep the stools soft and stress reduction by meditation and relaxation therapy are basic requirements for effective treatment and prevention of recurrence.
Methods listed below are applicable only to internal (inside the anus) hemorrhoid in early stages of formation.

Rubber band ligation	Elastic bands are applied onto an internal hemorrhoid to cut off its blood supply. Within several days, the withered hemorrhoid sloughs off during normal bowel movement.
Sclerotherapy (injection therapy)	Sclerosant or hardening agent is injected into hemorrhoids. This causes the vein walls to collapse and the hemorrhoids to shrivel up.
Cryosurgery	The frozen tip of a cryoprobe is used to freeze and destroy the hemorrhoid. Rarely used anymore because of delayed wound healing.
Laser, infrared or BICAP coagulation	Laser, infrared beam, or electricity is used to cauterize the hemorrhoid. Lasers are now much less popular.

What are the surgical treatment options for hemorrhoids (piles)?

These methods are applicable to both external and internal (outside & inside the anus) hemorrhoids in advanced stages of development. These can contribute to incontinence, usually of gas, later in life.

Hemorrhoidectomy	The entire hemorrhoid(s) is cut and removed and the wound may be closed. The anal sphincter muscle is often cut (Lateral sphincterotomy) to reduce pain and facilitate wound healing.
Stapled Hemorrhoidectomy	A circular surgical stapler is used to cut and remove the hemorrhoids and inner layers of the anal wall and join the cut ends. Hence it is ideal for hemorrhoids with prolapse. It is generally less painful than complete removal of hemorrhoids and also heals faster. It's meant for hemorrhoids that fall out or bleed and is not helpful for painful outside conditions.

	What is anal fissure?
	Anal fissure is a crack or tear in the skin at the anus (opening through which stools pass out). It may cause severe pain after defecation and bright red bleeding. These are often thought to be due to piles. Anal fissures are common in: Women after childbirth; High strung anxious stressed out individuals; those on low fiber diet who strain to pass hard stools.

How is anal fissure treated?

	A high fiber diet (or fiber supplement) and plenty of fluids help keep the stools soft, easy and quick to pass. Avoid chilly and pepper till the fissure heals. Also avoid dehydrating caffeine beverages. It is important to avoid straining to pass stools. Pass stools whenever you get the urge (usually after meals) and do not hold on to it.
	Stress reduction by Meditation and relaxation therapy, exercise, music is an essential for healing and avoiding recurrence. A tight anal opening leads to repeated trauma when passing stools, delayed wound healing and pain due to poor blood supply.
	Local applications include local anesthetic cream before passing stools, moisturizing cream after passing stools and cleaning up, muscle relaxing medications like nitroglycerine.
	Injecting botulinum toxin (Botox) into the anal sphincter to relax the muscle and promote healing by relieving anal spasm.
	Surgery may be required for persisting scarred deep anal fissures unresponsive to the above conservative measures. It involves removal of the anal fissure (Fissurectomy) and cutting the sphincter muscle (Lateral sphincterotomy)

	What is anal fistula?
	Anal fistula is a tunnel underneath the skin of the anus (opening through which stools pass out). It forms when an anal infection is left inadequately treated, leading to pus formation (Anal abscess) and later fistula. This presents as a recurrent swelling near the anus which spontaneously opens out to cause intermittent discharge of pus, sometimes blood stained.

How is anal fistula treated?

The underlying infection is treated with antibiotics and constipation with fiber supplements. The fistula can be

	Treated with a Seton (A piece of suture passed through the fistula and tied) - called Kshar Sutra Method in Ayurveda.
	Closed by injecting a biodegradable glue into it (Fibrin glue injection) or inserting a plug of porcine collagen tissue (Anal Fistula Plug) that provides a scaffolding into which the body tissues grow closing the fistula. These are recent methods of treatment
	Removed by surgery (Fistulectomy). If not removed entirely it continues to branch out and extend.

What is Pilonidal sinus?

Pilonidal literally means 'nest of hairs' in Latin. A pilonidal disease/ infection/ abscess/ cyst/sinus (PNS) is a common problem of young men and less often women. Pilonidal disease is associated with visible pits in the midline of the natal cleft and is more common among the profusely sweating hirsute, the obese, and those with sedentary occupation or who travel a lot. It occurs in the cleavage between the buttocks (natal cleft). Initially it may be a painless lump or swelling. It often causes discomfort, embarrassment and absence from work. When infected it causes pain and discharge.

How is Pilonidal sinus treated?

It is treated with antibiotics, pain relieving drugs and surgery to remove the infected material and if possible all the skin pits in the natal cleft. In severe infection a second surgery may required for this. The surgeon may choose to leave the wound open or close it or use plastic surgery. For the wound to heal, repeated removal of hair in and around the natal cleft, removal of hair and any debris from the wound is essential. Good personal hygiene and regular hair removal is important to prevent recurrence

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