Procedure of Anorectal Disorder

Anorectal disorders encompass a wide range of conditions affecting the anus and rectum, including hemorrhoids, anal fissures, fistulas, abscesses, rectal prolapse, and incontinence. These disorders can significantly impact a person’s quality of life, causing pain, bleeding, discomfort, and embarrassment. Thankfully, modern medical science offers multiple procedures and treatment pathways, ranging from non invasive techniques to advanced surgeries.

In today’s fast-paced world, where sedentary lifestyles, poor dietary habits, and increasing stress levels have become the norm, anorectal problems are on the rise. Conditions like hemorrhoids (piles), anal fissures, rectal prolapse, and anal fistulas are no longer limited to older adults; even young individuals are now experiencing these issues due to irregular bowel habits, prolonged sitting, and lack of fiber in the diet.

What is Anorectal Disorder?

Anorectal disorders are conditions that affect the lower end of the digestive tract. While some conditions are minor and resolve with lifestyle changes or medications, others may require medical or surgical intervention. Common anorectal disorders include :-

1. Hemorrhoids :- Swollen veins in the anal canal

2. Anal fissures :- Small tears in the lining of the anal canal

3. Anal fistulas :- Abnormal tunnels between the anal canal and the skin

4. Anorectal abscesses :- Collections of pus due to infection

5. Rectal prolapse :- Rectum protruding from the anus

6. Fecal incontinence :- Loss of control over bowel movements

Early identification and appropriate procedural management are key to successful outcomes.

Initial Evaluation and Diagnosis

1. Medical History and Physical Examination :- The first step in the management of anorectal disorders begins with a detailed medical history. The doctor will inquire about symptoms such as pain during bowel movements, rectal bleeding, itching, discharge, or the sensation of a lump. Personal habits, such as diet, bowel routine, and family history of gastrointestinal disorders, are also discussed.

   This is followed by a physical examination, which includes visual inspection of the anal area and a digital rectal exam (DRE). The DRE helps assess muscle tone, tenderness, and abnormalities such as masses or fissures.

2. Anoscopy and Proctoscopy :- To get a clearer view of the anal and rectal canal, doctors may use tools like an anoscope or proctoscope. These are small, tube-like instruments that allow the doctor to inspect the interior lining of the rectum and anus for hemorrhoids, inflammation, or tumors.

Procedure of Anorectal Disorder

If initial evaluations point to a more complex or internal issue, further investigations may be advised. These include :-

1. Colonoscopy or Sigmoidoscopy :- For persistent rectal bleeding or suspicion of colorectal cancer, a colonoscopy or flexible sigmoidoscopy may be performed. These procedures help visualize the entire colon and rectum using a camera-equipped flexible tube.
2. Imaging Tests :- In cases of suspected fistula, abscess, or complex rectal conditions, MRI (Magnetic Resonance Imaging) or endorectal ultrasound may be recommended. These help identify the extent of infection or abnormal tracts within tissues.

Treatment Procedure of Anorectal Disorder

Once a diagnosis is confirmed, treatment plans are formulated based on the severity and nature of the disorder. Let’s explore common procedures used to treat anorectal conditions.

1. Hemorrhoid Treatment Procedures :- Mild hemorrhoids often respond well to lifestyle changes, sitz baths, and topical medications. However, when they become large, painful, or prolapsed, procedural treatment is necessary.

   • Rubber Band Ligation :- This is the most commonly used outpatient procedure for internal hemorrhoids. A rubber band is placed around the base of the hemorrhoid, cutting off blood supply and causing it to fall off within days.

   • Sclerotherapy :- A chemical solution is injected into the hemorrhoid, causing it to shrink.

   • Infrared Coagulation (IRC) :- Heat from infrared light is used to cut off blood supply to the hemorrhoids.

   • Hemorrhoidectomy :- In severe cases, surgical removal of hemorrhoids is done under anesthesia. This offers permanent relief for recurring or complicated hemorrhoids.

2. Anal Fissure Treatment :- Acute anal fissures often heal with dietary changes, stool softeners, and topical creams such as nitroglycerin ointment or calcium channel blockers.

   If conservative treatment fails, the following procedures are considered :-

   • Botox Injections :- Botulinum toxin is injected into the internal anal sphincter to reduce spasms and promote healing.

   • Lateral Internal Sphincterotomy (LIS) :- A small portion of the sphincter muscle is cut to reduce pressure and allow the fissure to heal. This is considered the gold standard for chronic anal fissures.

3. Anal Fistula and Abscess Management :- Anal fistulas usually develop following an anorectal abscess. While abscesses require incision and drainage, fistulas often need surgery to prevent recurrent infections.

   • Fistulotomy :- The fistula tract is opened and cleaned to promote healing from the inside out.

   • Seton Placement :- In complex or high risk fistulas, a seton (a thread-like material) is inserted to allow drainage while minimizing the risk of incontinence.

   • Advancement Flap Procedure :- For high anal fistulas, tissue is used to cover the internal opening of the fistula after cleaning the tract.

4. Rectal Prolapse Procedures :- Rectal prolapse, often seen in elderly patients or those with chronic constipation, requires surgical repair.

   • Rectopexy :- The rectum is repositioned and secured to the sacrum using sutures or mesh. This can be performed laparoscopically or via open surgery.

   • Perineal Procedures :- For older or high risk patients, perineal rectosigmoidectomy (Altemeier procedure) may be preferred as it avoids abdominal surgery.

5. Procedures for Fecal Incontinence :- Fecal incontinence can result from nerve damage, muscle injury, or age-related weakness. Treatment begins with biofeedback therapy and pelvic floor exercises.

   For persistent cases, procedural interventions include :-

   • Sacral Nerve Stimulation (SNS) :- A device is implanted to stimulate the sacral nerves and improve bowel control.

   • Sphincteroplasty :- Surgical repair of a damaged anal sphincter muscle.

   • Artificial Bowel Sphincter :- A device is implanted to mimic the function of the sphincter muscle.

Post Procedure Care and Recovery

Post-procedural care plays a critical role in preventing complications and promoting healing. Patients are usually advised to maintain soft stools by consuming a high-fiber diet and staying well-hydrated. Sitz baths, pain relievers, and stool softeners are commonly prescribed. Follow-up visits ensure proper healing and monitor for recurrence.

When to See a Colorectal Surgeon

Anyone experiencing persistent anal pain, bleeding, unusual discharge, or changes in bowel habits should consult a gastroenterologist or colorectal surgeon. Early intervention not only prevents complications but also reduces the need for invasive procedures.

Conclusion

Anorectal disorders, though common, are often neglected due to embarrassment or fear. Fortunately, with advancements in diagnostic and surgical techniques, patients can achieve complete recovery with minimal discomfort.