Perianal Conditions

Evaluation and Treatment of Common Anal Disorders

Conditions affecting the area around the anus are very common and can cause symptoms such as pain, bleeding, swelling, or drainage. While these issues can be uncomfortable to discuss, they are well understood and often very treatable. Accurate diagnosis is key, as different conditions can present with similar symptoms but require different treatments.

Our approach focuses on relieving symptoms, addressing the underlying problem, and restoring normal function with the least invasive treatment appropriate for each patient.

Hemorrhoids

Hemorrhoids are swollen veins in and around the anal canal and are one of the most common causes of rectal bleeding and discomfort.

Internal Hemorrhoids

Internal hemorrhoids develop inside the anal canal and may cause:

Painless bleeding
A feeling of pressure or prolapse
Mucus discharge

Treatment depends on severity and may include dietary changes, medications, or office-based procedures.

External Hemorrhoids

External hemorrhoids form under the skin around the anus and can cause:

Pain or tenderness
Swelling
Irritation

Thrombosed Hemorrhoids

A thrombosed hemorrhoid occurs when a clot forms within an external hemorrhoid, leading to sudden and significant pain. When evaluated early, treatment may include excision in the clinic under local anesthesia, which often provides rapid relief. In other cases, symptoms may be managed conservatively as the clot resolves.

Hemorrhoid Banding

For selected internal hemorrhoids, rubber band ligation may be performed in the office. This involves placing a small band around the hemorrhoid to cut off blood flow, causing it to shrink and fall off over time. Banding is typically well tolerated and does not require anesthesia.

Surgical Hemorrhoid Excision

More advanced or recurrent hemorrhoids may require hemorrhoidectomy, which is performed in the operating room. This approach is reserved for cases where other treatments have failed or symptoms are severe, and it provides durable, long-term relief.

Anal Fissure

An anal fissure is a small tear in the lining of the anal canal that can cause sharp pain with bowel movements and bleeding. Many early fissures heal with conservative treatment such as stool softeners and topical medications.

Chronic Anal Fissure

When a fissure does not heal or becomes recurrent, surgical treatment may be recommended. The most effective operation is lateral internal sphincterotomy, a procedure that gently releases a portion of the internal anal sphincter muscle. This reduces spasm, improves blood flow, and allows the fissure to heal, with a high success rate and excellent symptom relief.

Fistula in Ano

A fistula in ano is an abnormal tunnel that forms between the anal canal and the skin near the anus. It usually develops after an anal gland infection or abscess that does not heal completely.

Pathophysiology

Infection begins in an anal gland
An abscess forms and drains
A persistent tract remains, leading to chronic drainage or recurrent infection

Fistulas rarely heal on their own and often require surgical treatment.

Evaluation and Exam Under Anesthesia

Proper evaluation of a fistula may require an exam under anesthesia (EUA). This allows careful identification of the fistula tract and its relationship to the anal sphincter muscles, which is critical in choosing the safest and most effective treatment.

Surgical Treatment Options

Treatment is individualized based on fistula anatomy and sphincter involvement. Options may include:

Fistulotomy for simple fistulas
Seton placement to allow drainage and protect sphincter function
LIFT procedure (Ligation of the Intersphincteric Fistula Tract) for selected cases

The LIFT procedure aims to close the fistula while preserving sphincter muscle, reducing the risk of incontinence.

Recovery and Follow-Up

Recovery varies depending on the condition and procedure performed. Most patients experience gradual improvement in symptoms over several weeks. Follow-up visits are important to monitor healing, manage discomfort, and ensure long-term success.

When to Seek Evaluation

You should consider evaluation if you experience:

Rectal bleeding
Persistent anal pain
Swelling or a new lump
Drainage near the anus
Recurrent abscesses

Early evaluation allows for simpler treatment and better outcomes.