Frequent diseases
Proctological diseases are widespread. Like any other medical speciality, Proctology, which deals with Diseases of the rectum, is confronted with very different clinical pictures from one person to another.
If you experience pain, clear bleeding, burning, oozing, swelling, tissue prolapse or purulent discharge, you should definitely consult a proctologist.
-
Anal condyloma (Condylomata acuminata)
- Anal condyloma
Condylomata are benign reddish, greyish or whitish swellings about the size of a pinhead, but can grow to several centimetres in length.
Condylomata are often found in the genital or anal region, tend to spread locally and are caused by infection with the HPV virus (Human Papilloma Virus).
Typical symptoms include itching and traces of blood on the toilet paper.
Treatment of condylomata of the anal region is difficult because the condition often recurs. Superficial condylomas can be destroyed by laser or surgery, but sometimes specific creams are sufficient.
It is strongly recommended to also examine the sexual partner(s), and to look for HIV (Human Immunodeficiency Virus) infection in people in high-risk groups. Certain HIV stereotypes are associated with an increased risk of rectal cancer, and clinical and paraclinical follow-up is therefore necessary.
- Anal condyloma
-
Anal eczema
- Anal eczema is a disorder of the anus referred to by inflammatory skin changes in the anal region associated with sweating.
Acute alteritis is characterised by a subsequent reddening of the skin, whereas chronic alteritis presents thick, whitish licking of the skin, most often associated with scratching lesions linked to itching.
Eczema is most often linked to repeated aggression to the skin of the anal region, such as a lack of hygiene or, on the contrary, too much hygiene or chronic and/or repeated diarrhoea. However, proctological pathologies such as haemorrhoids, anorectal polyps, anal fissures, anal fistulas, corclylomas or anal incontinence may also be involved.
These pathologies must be treated in order to cure eczema once and for all.
Intestinal transit must be regulated, so that stools are moulded and painless.
The first step is to clean the area with clean water, followed by the application of a zinc-based ointment. Local applications of corticosteroids may also be necessary.
However, it is essential to have ruled out other diagnoses such as psoriasis, viral infection, mycosis, etc.
- Anal eczema is a disorder of the anus referred to by inflammatory skin changes in the anal region associated with sweating.
Acute alteritis is characterised by a subsequent reddening of the skin, whereas chronic alteritis presents thick, whitish licking of the skin, most often associated with scratching lesions linked to itching.
-
Anal fissure
- An anal fissure is a tear in the anal canal that is extremely painful. These pains appear during defecation and can then last from a few minutes to a few hours. The pain is often accompanied by clear bleeding.
Acute anal fissures often heal with stool control and certain creams.
However, if an anal fissure does not heal, chronic changes occur, such as newly formed external skin folds and changes in the connective tissue in the anal canal, associated with reduced pain. These chronic fissures are very difficult to heal conservatively and can lead to anal fistulas/abscesses which can destroy the sphincter and make it impossible to heal the fissure. These chronic fissures often need to be operated.
- An anal fissure is a tear in the anal canal that is extremely painful. These pains appear during defecation and can then last from a few minutes to a few hours. The pain is often accompanied by clear bleeding.
-
Anal fistulas and abscesses
- In the transition zone between the mucous membrane of the rectum and the skin of the anal canal, men have small taschan-shaped formations called crypts, at the base of which are glands. These glands can become inflamed and form fistulas or abscesses.
A fistula is a channel lined with epithelium that starts in the crypts, crosses the sphincter and opens in the skin. Bloody or purulent secretions often escape from the external opening of the fistula; when this external opening is closed, an abscess forms.
Fistulas never heal spontaneously and have always to be operated.
If the fistulas only cross part of the sphincter, they can simply be dissected. However, fistulas often involve a larger part of the sphincter and must therefore be treated surgically, with suturing of the sphincter muscles. This is not possible if there is too much local inflammation, as the suture would not hold. In this case, a silicone suture should first be applied and then, once the inflammation has improved and the wounds have healed, the fistula can be dissected and the sphincter muscle sutured.
If secretions are retained locally, an abscess may form. Abscesses in the sphincter area are very painful and can destroy the sphincter if they are not operated on as a matter of urgency.
In the case of anal abscess, there is usually an associated anal fistula. To avoid any recurrence of the abscess, the fistula must be sought out and treated. Fistulas can occur in people of all ages and sexes.
Chronic inflammatory bowel disease is, however, a risk factor for anal fistulas.
- In the transition zone between the mucous membrane of the rectum and the skin of the anal canal, men have small taschan-shaped formations called crypts, at the base of which are glands. These glands can become inflamed and form fistulas or abscesses.
-
Marisques
- Anal moles are folds of skin on the anal margin caused by Haemorrhoids and are usually harmless.
They may occasionally become inflamed, pointing to other pathologies.
They are only treated surgically when there is an aesthetic problem, when they create local hygiene problems or when they become complicated.
- Anal moles are folds of skin on the anal margin caused by Haemorrhoids and are usually harmless.
-
Coccyx cyst (Pilonidalsinus)
- These are often asymptomatic, apart from a small excavation in the coccyx from which small branching ducts may emerge, containing a few hairs.
Cysts can occasionally become inflamed, leading to redness, oedema and even abscesses in the hypodermis, which may require emergency surgery.
During surgery, care must be taken to dissect and remove all the epithelial ducts to avoid recurrence.
The wound may be closed and sutured or left open.
- These are often asymptomatic, apart from a small excavation in the coccyx from which small branching ducts may emerge, containing a few hairs.
-
Anal/fecal incontinence
- Anal incontinence is a public health problem, the incidence of which is increasing due to longer life expectancy and is linked to insufficient/inadequate control of bowel contents.
This can have a profound effect on quality of life and have significant social repercussions for sufferers.
Fecal incontinence (as well as urinary incontinence) is linked to sphincter failure. Depending on the severity of sphincter dysfunction, there are three grades of anal incontinence:
Grade 1: uncontrolled loss of gas
Grade 2: uncontrolled loss of loose stools or diarrhoeal discharge
Grade 3: uncontrolled loss of hard stools.
Anal tightness is ensured by a combination of neurological, muscular and sensory factors.
Age-related changes to the anal sphincter, local stresses caused by pregnancy and childbirth, and medical interventions in the anal canal can all lead to incontinence-like symptoms.
It is therefore advisable to start perineal re-education at an early stage. If this proves insufficient, anal stimulation and/or biofeedback are other methods with proven effectiveness. For some people, surgery or neural modulation of the sacral nerves may even be suggested.
However, an important factor in combating anal incontinence is good bowel regulation.
Treatment is multidisciplinary, involving gastroenterologists, neurologists, endocrinologists, gynaecologists, urologists, surgeons, radiologists, psychologists, physiotherapists and dieticians.
- Anal incontinence is a public health problem, the incidence of which is increasing due to longer life expectancy and is linked to insufficient/inadequate control of bowel contents.
-
Defecation problems
- Defecation problems are characterised by an inability to evacuate faeces completely and effectively from the rectal ampulla.
Causes include stenosis of the anal canal, rectocele, descent of the perineum or damage to the rectum.
A common misconception is that you need to have at least one bowel movement a day (whereas the norm is two or three times a day, or once every three days). Complete and effective defecation is particularly important.
- Defecation problems are characterised by an inability to evacuate faeces completely and effectively from the rectal ampulla.
Causes include stenosis of the anal canal, rectocele, descent of the perineum or damage to the rectum.
-
Thrombosis of the anal veins / Thrombosis of the peri-anal veins
- Anal vein thromboses are painful indurations in the perianal area, often called external haemorrhoids. These clots form spontaneously, secondary to thrombosis of the external veins. Constipation, diarrhoea, pregnancy or sitting on (excessively) hot or cold surfaces are frequent causes.
Unlike venous thrombosis of the lower limbs, anal vein thrombosis is neither threatening nor dangerous. They are usually treated conservatively, but can be removed under local anaesthetic if pain and/or discomfort are significant.
- Anal vein thromboses are painful indurations in the perianal area, often called external haemorrhoids. These clots form spontaneously, secondary to thrombosis of the external veins. Constipation, diarrhoea, pregnancy or sitting on (excessively) hot or cold surfaces are frequent causes.
-
Haemorrhoids
- Haemorrhoids are physiological, submucosal vascular (venous) bundles located at the junction between the rectum and the anal canal.
Haemorrhoids can enlarge and become particularly painful and disabling. The most common complaints are bleeding, pruritus, oozing or a burning sensation associated with pain. In addition, the perianal area may feel heavy and defecation may be difficult.
If these symptoms appear, we are talking about haemorrhoidal pain and treatment is indicated.
The creams and suppositories widely prescribed are part of the symptomatic treatment to combat pain and/or discomfort, but have no curative value. Depending on the stage of haemorrhoidal suffering, the haemorrhoids may be sclerosed, ligated or, in the case of advanced haemorrhoids, operated on.
Haemorrhoids I: Haemorrhoids not prolapsed, but only oedematous
Haemorrhoids II: Intermittent procidence when pushing, but spontaneously reducible after a bowel movement
Haemorrhoids III: A permanent procidence that can only be reduced manually after a bowel movement
Haemorrhoids IV: An irreducible procidence.
- Haemorrhoids are physiological, submucosal vascular (venous) bundles located at the junction between the rectum and the anal canal.
-
Perineal descent of the perineum or descent of organs
- As a result of orthostatism, the perineum is exposed to support stresses that can ultimately weaken it. Similarly, pregnancy, childbirth, the practice of various sports, excess weight and defecation disorders such as constipation are other causes of alteration and dysfunction of the muscles and support tissue of the perineum.
In addition to the sensation of pelvic heaviness, defecation problems, micturition problems and anal and/or urinary incontinence are also common.
The treatment involves regular bowel movements, combating constipation, strengthening the muscles of the perineum and avoiding carrying heavy loads.
- As a result of orthostatism, the perineum is exposed to support stresses that can ultimately weaken it. Similarly, pregnancy, childbirth, the practice of various sports, excess weight and defecation disorders such as constipation are other causes of alteration and dysfunction of the muscles and support tissue of the perineum.