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 Dr.Dragos Iorgulescu General Surgeon
Dr.Dragos Iorgulescu General Surgeon 
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Anal/Perianal

Anus is the opening end of the digestive tract through which the body wastes or excreta are passed out of your body. Perianal is the area around the anus.

Some of the common disorders of anal/perianal area include cancer, anal fissures, hemorrhoids, anal fistula, and abscess.

Anal fissure - Fissure is a painful condition because of the tear in the inner lining of anus. It is common in people of all ages. Anal fissure are caused when a hard stool requiring stretching of anal opening is passed, and in other condition such as prolonged diarrhea, inflammatory bowel disease, or sexually-transmitted diseases in this area. In fissures, blood vessels lining the anal opening may tear up causing blood loss in stools. Drinking lots of water, a fiber-rich diet, applying prescription creams or lotions in the anal area would help treat the fissure. In chronic cases, lateral internal sphincterotomy may be performed. It is a surgical technique where the lower one-third to one-half of the sphincter is divided that minimizes the resting pressure while retaining the effect of sphincter.

Perianal/Anal abscess - Abscess is the collection of pus in the cavities. Perianal abscess is the abscess in superficial tissues around anus and perirectal abscess is the abscess in deep tissues surrounding the anus. It is caused when there is an infection in the anal opening. Due to the infection pus gets collected in the anal and perianal tissues that burst out causing pain and inflammation. It is treated by draining out the pus and may also require surgery to treat the condition.

Anal fistula - Anal fistula is a narrow tunnel like structure that connects the previously infected glands around the anal area and the skin on buttocks outside the anus. This is a condition where pus or fluid is excreted out of the anus. It is generally observed after abscess is drained and if the tunnel persists. Treatment includes pain relievers to relieve pain or treated with warm water, high-fiber diet, using a stool softener which soften or loosen the stool. Permanent treatment requires surgery where fistula tunnel is opened up by cutting a small portion of the anal sphincter, followed by joining the external and internal openings of the tunnel and converting it to a groove. This will allow it to heal from the inside out.

Anal cancer - This is caused when malignant cancer causing cells grow and multiply in the anus, around anal region, or even large intestine (colon). Infection with human papilloma virus (HPV), multiple sexual partners, and anal fistulas may increase the risk of anal cancers. The treatment options would include radiation therapy, chemotherapy, or surgery. Surgery may be a local resection-where the cancerous tissue along with small healthy tissue around the cancer is resected; or abdominoperineal resection-where the anus, the rectum, and part of the sigmoid colon are removed through an incision in the abdomen.

Hemorrhoids - These are commonly called as ‘piles’. The veins in and around the anus or in large intestine swell up due to the pressure exerted on the anus, strain caused by constipation, lack of fiber in the diet, or pregnancy. Treatment includes:

  • Rubber band ligation - a band is placed around the base of hemorrhoid that cuts off the circulation causing the hemorrhoid to shrink

  • Sclerotherapy - an irritant solution is injected into the blood vessel that shrinks hemorrhoid

  • Infrared coagulation - Heat is used to shrink the hemorrhoids

Large external hemorrhoids are removed by surgical treatment.

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