Anorectal Diseases and Conditions

HIV-related conditions

It is estimated that at least one-third of HIV-positive patients suffer from an anal disorder and that anorectal disease is the most common reason for surgery in these patients. Pain or severe discomfort is the most common symptom. Other symptoms may include:

  • a mass or swelling
  • blood or bloodstained discharge
  • Pruritus (itching)
  • painful defecation
  • incontinence
  • diarrhea

Surgical treatments can address abscesses, active infected fistulas, anal ulcers, complicated hemorrhoids and extensive condylomata. Surgical intervention in the treatment of anal disease, should be carefully considered, because of the possibility of delayed wound healing and even non-healing.

Fecal Incontinence

Fecal incontinence is the inability to control your bowels. Fecal incontinence can have several causes:

  • constipation
  • damage to the anal sphincter muscles
  • damage to the nerves of the anal sphincter muscles or the rectum
  • loss of storage capacity in the rectum
  • diarrhea
  • pelvic floor dysfunction

Fecal incontinence work up includes anorectal physiologic studies which uses specialized equipment to study the anal sphincter muscle and function, and the strength of nerves in this region.

Treatment for fecal incontinence depends on the cause and severity of the condition, and may include dietary changes, medication, pelvic floor physical therapy, or surgery.

Hemorrhoids

Hemorrhoids veins around the anus and lower rectum. Sometimes these veins become swollen and inflamed veins causing hemorrhoidal symptoms. The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. Hemorrhoids can also prolapse out of the anal area causing bleeding and discomfort.

Treatments for internal hemorrhoids may include:

  • Rubber band ligation, in which a special rubber band around the base of the hemorrhoid. The band cuts off circulation, causing the hemorrhoid to shrink. Only a doctor should perform this procedure.

Large external hemorrhoids or internal hemorrhoids that do not respond to other treatments may also be surgically removed.

There are a number of surgical options for treating symptomatic hemorrhoids.

Transanal Hemorrhoidal Dearterialization with Hemorrhoidopexy (THD) is a less invasive surgical procedure that successfully treats most internal hemorrhoids. This procedure is effective, causes less pain, and is associated with a faster post operative recovery.