Anorectal Disorders

Anorectal disorders are a group of medical disorders that occur within the anal canal and rectum. Often these conditions are a source of discomfort, pain, embarrassment, and worry.

Our colon and rectal surgery experts at Mayo Clinic Health System in La Crosse specialize in the treatment of anorectal disorders including:

Hemorrhoids

Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids).

Nearly 3 out of 4 adults will have hemorrhoids from time to time. Hemorrhoids have several causes, but often the cause is unknown.

You often can relieve the mild pain, swelling and inflammation of hemorrhoids with home treatments including:

• Eating high-fiber foods
• Using topical treatments
• Soak regularly in warm bath
• Take oral pain relievers

If medical treatment is needed for the treatment of your hemorrhoids, your doctor may recommend rubber band ligation. During this procedure, your doctor places one or two tiny rubber bands around the base of an internal hemorrhoid to cut off its circulation. The hemorrhoid withers and falls off within a week.

Only a small percentage of people with hemorrhoids require surgery.

However, if other procedures haven't been successful or you have large hemorrhoids, your doctor might recommend one of these surgical procedures:

• Hemorrhoid removal
  Choosing one of various techniques, your surgeon removes excessive tissue that causes bleeding. The surgery can be done with local anesthesia combined with sedation, spinal anesthesia, or general anesthesia. Hemorrhoidectomy is the most effective and complete way to treat severe or recurring hemorrhoids. Complications can include temporary difficulty emptying your bladder, which can result in urinary tract infections. This complication occurs mainly after spinal anesthesia. Most people have some pain one to three days after the procedure, which medications can relieve. Soaking in a warm bath also might help.
• Hemorrhoid stapling
  This procedure blocks blood flow to hemorrhoidal tissue. It is typically used only for internal hemorrhoids. Stapling generally involves less pain than hemorrhoidectomy and allows for earlier return to regular activities. Compared with hemorrhoidectomy, however, stapling has been associated with a greater risk of recurrence and rectal prolapse, in which part of the rectum protrudes from the anus. Complications can also include bleeding, urinary retention, and pain, as well as, rarely, a life-threatening blood infection (sepsis). Talk with your care team about the best option for you.

When to talk to your doctor

If you have bleeding during bowel movements or you have hemorrhoids that are bothersome, talk to your doctor. Don't assume rectal bleeding is due to hemorrhoids, especially if you have changes in bowel habits or if your stools change in color or consistency. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. Seek emergency care if you have large amounts of rectal bleeding, lightheadedness, dizziness or faintness.

Fissures

An anal fissure is a small tear in the thin tissue that lines the anus. An anal fissure may occur when you pass hard or large stools during a bowel movement. Anal fissures typically cause pain and bleeding with bowel movements. You also may experience spasms in the ring of muscle at the end of your anus (anal sphincter).

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.

If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, your doctor may recommend surgery. Doctors usually perform a procedure called lateral internal sphincterotomy (LIS), which involves cutting a small portion of the anal sphincter muscle to reduce spasm and pain and promote healing. Studies have found that for chronic fissure, surgery is much more effective than any medical treatment.

Fistulas

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract (anus).

Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland.

Treatment of anal fistula depends on the fistula's location and complexity. The goals are to repair the anal fistula completely to prevent recurrence and to protect the sphincter muscles. Damage to these muscles can lead to fecal incontinence.

The options include:

• Fistulotomy
  The surgeon cuts the fistula's internal opening, scrapes and flushes out the infected tissue, and then flattens the channel and stitches it in place. To treat a more complicated fistula, the surgeon may need to remove some of the channel. Fistulotomy may be done in two stages if a significant amount of sphincter muscle must be cut or if the entire channel can't be found.
• Advancement rectal flap
  The surgeon creates a flap from the rectal wall before removing the fistula's internal opening. The flap is then used to cover the repair. This procedure can reduce the amount of sphincter muscle that is cut.
• Seton placement
  The surgeon places a silk or latex string into the fistula to help drain the infection.
• Fibrin glue and collagen plug
  The surgeon clears the channel and stitches shut the internal opening. Special glue made from a fibrous protein is then injected through the fistula's external opening. The anal fistula tract also can be sealed with a plug of collagen protein and then closed.
• Ligation of the intersphincteric fistula tract (LIFT)
  LIFT is a two-stage treatment performed for more-complex or deep fistulas. LIFT allows the surgeon to access the fistula between the sphincter muscles and avoid cutting them. A seton is first placed into the fistula tract, forcing it to widen over time. Several weeks later, the surgeon removes infected tissue and closes the internal fistula opening.

In cases of complex fistula, more-invasive procedures may be recommended, including:

• Ostomy and stoma
  The surgeon creates a temporary opening in the abdomen to divert waste into a collection bag, to allow the anal area time to heal.
• Muscle flap
  In complex anal fistulas, the channel may be filled with healthy muscle tissue.