Anorectal Disorders

The most common anorectal disorder is hemorrhoids, which occur when veins in the rectum and anal canal become enlarged and inflamed. Hemorrhoids are often caused as a result of constipation, bearing down during childbirth or simply by aging. They are most often associated with pain and bleeding. Most hemorrhoids improve on their own or with medical treatment such as topical creams.

Advanced Hemorrhoid Treatments

Sometimes hemorrhoids are severe enough to warrant their removal. This can often be done with a minimally invasive outpatient procedure such as banding, coagulation therapy or injection therapy. In more advanced cases, hemorrhoids may require surgical removal (hemorrhoidectomy) or a procedure called Transanal Hemorrhoidal Dearterialization. The colon and rectal surgeons at AdventHealth Digestive Health Institute are experienced in evaluating hemorrhoids and work with patients to determine which treatment option is right for each individual.

An anal fissure is a small tear in the anal lining that often leads to bleeding, pain and/or itching. Anal fissures can be caused by hard bowel movements, childbirth, diarrhea or anal inflammation. Some people with Crohn’s disease are prone to developing anal fissures.

Although they can be painful, most anal fissures are not serious and can be treated at home with over-the-counter creams. However, fissures that have not healed after eight or more weeks require medical attention. Nonsurgical options, including dietary changes, nitroglycerine cream and prescription medicines, can often heal a fissure. If those options still do not work, then surgery may be needed.

Surgery to Treat a Chronic Anal Fissure

Lateral internal sphincterotomy is the standard surgery to treat an anal fissure that will not go away after other treatments. The procedure involves cutting or stretching the internal sphincter muscle that surrounds the anal canal. This relieves the tension this muscle is usually under. With this tension gone, sphincter muscle spasms are prevented, allowing healing to occur.

However, because sphincterotomy puts some patients at high risk for fecal incontinence, the colorectal surgeons at AdventHealth Digestive Health Institute may decide that an anal advancement flap procedure is a better surgical option in some cases. This approach is a sphincter-preserving surgery. Instead of the sphincter being cut, the surgery involves transferring nearby skin to the anus. Because this healthy skin already has a good blood supply, it helps the anal fissure heal as normal tissue would.

When the glands around the anus get clogged and infected with bacteria, an anorectal abscess, or pus-filled sac, can form. The abscess can cause pain, bleeding, and fever. Antibiotics alone cannot usually be used for treatment, and surgery to drain the abscess is often needed.

However, in about 50 percent of anal abscesses, a tunnel is formed from the gland to the outside of the skin. This tunnel is called an anal fistula. It can be a very painful condition, and sometimes stool can leak through the fistula.

Surgery to Treat Anal Fistula

If the anal fistula does not involve too much of the sphincter, a procedure called a fistulotomy is used to fix the condition. This procedure is complex and requires a trained colorectal surgeon. The muscle and skin on top of the infected area are cut open. Sometimes this requires a small part of the anal sphincter to be cut. The result is an open channel that heals from the inside out. A seton drain made of a thin piece of rubber is often used to reduce inflammation so the fistula can heal. Depending on the size and depth of the fistula, a fistulotomy can be performed in the surgeon’s office under local anesthesia or at the hospital with general anesthesia.