Hemorrhoids, Fissures, and Fistula Overview

Hemorrhoids affect about 75% of the population by age 50. And, they are common in pregnancy. While hemorrhoids are not dangerous, they can bleed and become painful when they are in the skin around the anus. A hemorrhoid is a cluster of swollen and inflamed veins in the lowest most part of the rectum.

The hemorrhoid may be internal, inside the lower rectum, and may protrude through the anus. The only symptom may be bleeding after a bowel movement, or blood in the stool. However, when the hemorrhoid protrudes it can collect mucus and microscopic amounts of stool that can cause external itching, pain and discomfort.

External hemorrhoids develop in the skin that surrounds the anus. Sometimes blood clots can occur in external hemorrhoids (Thrombosis). This can cause bleeding, swelling and a hard lump around the anus. When the clot resolves extra skin is left behind and it can become irritated and itchy. Rubbing and cleaning around the anus can make the symptoms worse.

Often the symptoms disappear after a few days, and some people are not aware they even have a hemorrhoid because they never have symptoms.

Causes

Hemorrhoids are associated with chronic constipation, straining during bowel movements and siting too long on the toilet, because this interferes with blood flow, which can cause blood to pool and enlarge the blood vessels. It is essentially a varicose vein in the anus.

Diagnosis

Because the symptoms of a hemorrhoid are similar to those of other anorectal problems like fissures, abscesses, warts and polyps, a physical exam and a digital rectal exam are employed to evaluate and diagnose hemorrhoids. Any bleeding from the rectum requires a thorough exam to rule out other digestive diseases that can also cause bleeding. In people over the age of 40, a colonoscopy, sigmoidoscopy and barium enema x-rays may be used to rule out other causes, like colon cancer.

Home treatment

At home treatment includes lifestyle changes to reduce swelling and relieve symptoms. A high fiber diet softens the stool and makes it easier to make a bowel movement, eliminating straining. Stool softeners may be recommended. Staying hydrated, exercising, can relieve constipation and prevent straining.

When a hemorrhoid forms a blood clot, it can be very painful. Topical pain creams offer temporary pain relief, but where the clot exists more than 2 days, home treatment can help. But if the clot is new, surgical removal in an office procedure.

Medical treatment

Medical treatment for internal hemorrhoids include rubber band ligation, hemorroidectomy- cutting out the hemorrhoid, or staple hemorrhoidopexy.

Anal fissures

An anal fissure is a split or tear in the mucosa that lines the anus, that causes pain and bleeding with bowel movements. They are most common in infants, and are less common in school aged children. In adults, they may be caused by hard stool or diarrhea for an extended period. Additionally, a fissure may be due to decreased blood flow in older adults and high tension in the sphincter muscles. And fissures are common in people with Crohn’s disease.

Symptoms include sharp pain during a bowel movement and bleeding, a crack in the skin of the anus that is visible when the skin is stretched, and constipation. Anal fissures are diagnosed by a rectal exam and visualization of the area. But fissures are often confused with hemorrhoids.

Treatment

Treatment is aimed at softening stool and relaxing the anal sphincter to promote healing.

Most fissures heal on their own within 1-2 weeks. In infants, changing diapers often and cleaning the area can prevent and treat them. Dietary changes to include more fiber and fluids, plus topical creams can soothe the area.

Chronic fissures are more difficult to treat than acute fissures, and can reoccur. If the fissure does not heal with lifestyle improvements, a patient should seek medical help to assure there is no underlying disease. Surgical options include Botox injection into the sphincter to relax it which will decrease pain and allow healing. Botox treatment can heal 50-80% of patients. A procedure called a sphincterotomy is reported to be 90% effective.

Anal Fistulas

An abscess is an infected area near the anus that is filled with pus. An anal fistula is commonly the result of a previous or current anal abscess. Small glands in the anus can get clogged and become infected, causing an abscess. A fistula is a tunnel the forms under the skin that connects the infected glands to the abscess. But a fistula can develop without an abscess and connect the gland with the skin near the anus. Crohn’s disease, radiation, trauma and cancer can cause a fistula.

Symptoms include pain, redness and swelling, plus irritation of the skin around the anus and drainage of the abscess through the fistula. Fatigue, and fever or chills are common.

Most fistulas and abscesses are diagnosed by clinical findings. If there are deep abscesses or the fistula is not well delineated, imaging studies will help diagnose the situation.

Treatment is surgical drainage of the abscess. Antibiotics may be prescribed in addition to surgical drainage. Surgery is necessary to cure a fistula.

The general surgeons at BASS Medical Group are board-certified and experienced in hernia diagnosis and repair, and they are Fellows of the American College of Surgeons. Our multi-specialty group is dedicated to your health and well being. Choosing the right surgeon to perform your surgery is one of the most important decisions a patient can make. Our offices are in San Francisco and the East Bay, California, to serve our patients. Find the location convenient to you. Then call BASS Medical Group to schedule a consultation to discuss your concerns, get answers to your questions and receive professional, quality care.