HEMORRHOIDS, FISSURE IN ANO, FISTULA IN ANO

 

HEMORRHOIDS (PILES) 

Q. What are hemorrhoids and how does it presents?

A. Hemorrhoids also called as piles, are the engorged mass of veins in the anal canal which presents with painless bleeding (fresh bright red blood) during defecation that is passage of stools. Some times this pile mass can also prolapse out of anal canal.

 

Q. Why does hemorrhoids (Piles) develop?

A. They develop due to undue straining at stools, constipation and incorrect bowel habits. In pregnant females they can also develop due to pressure of the developing fetus (baby) on the abdominal veins.

 

Q. How can hemorrhoids (Piles) be prevented?

A. By eating lot of raw vegetables and fruits and having diet full of fibers. Also, not to strain at stools and prevent constipation.

 

Q. How are hemorrhoids treated?

A. They are treated by banding / injection sclerotherapy - First and second grade hemorrhoids. For third and fourth grade hemorrhoids either conventional surgery or stapler is used to treat the condition.

 

Q. What is banding and how is it done?

A. Banding is the application of the special rubber band around the neck (root) of the hemorrhoid to cause the vessels within it to thrombose and the whole pile mass then just falls off.

 

Q. Is banding painful?

A. No banding is not painfull and it done under topical anaesthesia and is day care (OPD) procedure which just takes few minutes to complete.

 

 

Fissure in Ano

Q. What is anal fissure?

A. It is a longitudinal tear in anal canal due to hard fecal mass due to constipation.

 

Q. How does it present?

A. It presents as painful condition during passage of stools with streaking of stools with blood in a straight line. It is a very painful condition in acute phase. In chronic condition it gives a feeling of incomplete evacuation of stools.

 

Q. How can it be prevented?

A. It can be prevented by eating lots of raw vegetables and fresh fruits. The constipation must be treated to prevent recurrence of anal fissure.

 

Q. Can anal fissure be treated medically or some surgery is required for its management?

A. 95% of Anal fissure can be treated medically only in some 5% of cases is surgery required.

 

Q. What is the surgery done for Anal Fissure?

A. The Lateral sphincterotomy is done for anal fissure. It is a simple operation if performed by an expert and takes just 10 to 15 minutes time.

 

 

Fistula in Ano

 

Q.  What is the treatment for fistula in Ano?
A. The conventional treatment for fistula in Ano is surgery which is laying open the fistulous tract. The conventional surgery for fistula is disfiguring and leaves a permanent scar. Also, it is painful and requires post surgery rest and dressings.

Q. What are the other methods of management of fistula in Ano?
A. The other non-surgical methods of treatment are placement of medicated seton (Kshar sutura) or by endoscopic technique that is VAAFT (Visually Assisted Anal Fistula Treatment) with fibrin glue insertion.

Q. How is medicated seton (Kshar sutura) treatment done?
A. It is done by placement of the medicated seton (kshar sutura) through the fistulous tract and tightening the thread. Over time the thread slowly cuts through the fistula and simultaneous healing takes place. It is suited for patients of fistula who do not want surgery and do not want admission. It is cheap and affordable treatment for fistula in Ano and does not require general anaesthesia, the tract can be cannulated under local anaesthesia.

Q. What are the Problems faced in the treatment of fistula in Ano with medicated seton (Kshar sutura)?
A. The technical problems faced are multiple visits for the change of the Medicated seton (Kshar sutura) usually done after 3 to 4 weeks or when the seton becomes loose. The discomfort faced while changing of the seton and long time to cut through the tissue with associated healing of the fistulous tract.

 

Q. What are the results after medicated seton (Kshar sutura) treatment?
A. The end results are excellent with minimal scarring and very less chances of recurrence.

 

Q. What is VAAFT with fibrin glue insertion?
A. VAAFT is Visually Assisted Anal fistula treatment for simple fistulas. The fistulous tract is cleaning using a small telescope, the anal gland is cauterized and the tract filled up with fibrin glue or internal opening is closed using a clip. The limitation of the technique is technical difficulty faced in complex fistulas with abscess and multiple tracts. The treatment is costly are requires general / regional anesthesia.  and cost of fibrin glue / clip application is added in the treatment

 

Q. What are chances of recurrence after fistula treatment after VAAFT?
A. After VAAFT (endoscopic treatment) the recurrence rates are low depending upon the type of fistula and presence of infection. Even small amount of infection can destroy fibrin glue. VAAFT is relatively new endoscopic technique of fistula treatment and long term follow up studies are still going on.