Proctology

Proctology or coloproctology. It is the specialty of medicine derived from general surgery that provides surgical and non-surgical diagnosis and treatment of diseases of the colon , rectum and anus .

The spectrum of coloproctology exercise includes the management of ostomies , colonoscopies , laparoscopic surgery , anal manometry , pelvic floor dysfunction and defecography , among others.

Summary

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  • 1 Diseases treated by a coloproctologist
    • 1 Perianal abscess
      • 1.1 Causes and symptoms
      • 1.2 Treatments
    • 2 Anal itching
      • 2.1 Causes
    • 3 Fissures
      • 3.1 Features and treatments
    • 4 Perianal fistula
    • 5 Hemorrhoids
      • 5.1 Causes
      • 5.2 Treatments
    • 2 Diverticular disease
    • 3 Related specialties
    • 4 Source

Diseases treated by a coloproctologist

There are a large number of diseases and symptoms for which it is advisable to go to a Colon and Rectum Surgery Specialist:

  • Fecal incontinence and constipation .
  • Hemorrhoids or hemorrhoidal disease.
  • Abscesses , fistulas and [[anorectal infections.
  • Perianal dermatosis.
  • Prolapse and rectal ulcer
  • Tumors of the colon, rectum and anus
  • Rectoanal lesions by Radiotherapy
  • Diseases of the cecal appendix
  • Colorectal endometriosis
  • Colon diverticula
  • Inflammatory bowel disease
  • Colon angiodysplasias
  • Colon and rectum polyps
  • Cancer of the colon , rectum and anus
  • Volvulus
  • Rectocele

Perianal abscess

Home: Perianal abscess

It is the accumulation of pus that arises from an abnormal communication that exists between the anal canal and the skin around the anus, which is called a perianal fistula.

Causes and symptoms

Its origin in most cases (90%) is due to inflammation of some glands due to obstruction at the outlet of these in the thickness of the anal canal. The rest of the causes are due to other pathologies such as Crohn’s disease , tuberculosis , tumors and even trauma in this region.

Its most important symptom is pain in the perianal area, sometimes accompanied by fever and chills. When there is an inflammatory, reddish, and warm volume increase in the margin of the anus, the diagnosis is practically made. Diagnosis is not always that easy, so it is sometimes necessary to perform an endosonography or an MRI to identify the exact location of the abscess.

Treatments

Treatment is always surgical, and its delay is not recommended, due to the risk of spreading the infection . What is done is a drainage of the purulent material under local or general anesthesia, with antibiotics and analgesics being associated . If a patient is not treated promptly, he can develop serious complications such as a systemic infection or gangrene of the area.

Approximately half of patients with an abscess will progress to a perianal fistula , in which communication between the anal canal and the skin around the anus is established. These patients report discharge as pus permanently, associated with pain and bleeding at times. Its surgical treatment, which must be carried out by a specialized team, since there is a risk of cutting a small portion of the anal sphincter muscle . Surgery can be performed on an outpatient basis or with a short hospital stay.

Anal itching

Anal itching or itching is the itching of the skin around the anus. Over time it can also spread to the vulva or scrotum . It is not a disease but a symptom.

It occurs frequently at night and occurs mainly in males between the ages of 20 and 50. The perianal region has many receptors for itching and a high density of sweat glands .

Causes

Sometimes, the cause is some disease of the perianal region such as leaking of feces to that area, fissures, fistulas or hemorrhoids.

At other times, there is no single cause of itching, so many factors converge for it to occur (excessive hygiene of the anus, some foods such as chocolate , milk , fruit juices, irritation due to sweating, detergents , soaps , etc.).

In addition, some diseases such as psoriasis , dermatitis , eczema , allergies , anal cancer, fungi , parasites , diabetes , etc. are the cause of pruritus .

This symptom should make the patient consult for a careful examination and thus determine the definitive cause and deliver the specific treatment.

Fissures

It is a wound in the skin that surrounds the anus, very painful and that can sometimes bleed. Pain sometimes motivates the person not to defecate to avoid it.

Features and treatments

Its cause, in the vast majority of cases, is caused by hard evacuations, or by episodes of frequent diarrhea that can also injure this area, especially if they are accompanied by intense pushing. Fissures can be classified as acute or chronic depending on the evolution time.

Most patients with an acute anal fissure respond satisfactorily to medical treatment, which consists of increased fiber and liquid in the diet, sitz baths with lukewarm water and sometimes your doctor may prescribe creams with medications that relax the anal sphincter, promoting faster recovery.

Patients with chronic anal fissure that do not respond to medical management can be offered surgery, which includes from the placement of botulinum toxin to the section of a fraction of the internal anal sphincter, thereby relaxing the hypertonia of this, greatly improving the quality of life of the patient.

Perianal fistula

A fistula is a connection or tunnel between the anal gland and the outside of the perianal skin. A perianal fistula almost always results from an abscess, with other causes such as Crohn’s disease .

The patient with abscess presents significant perianal pain, which prevents him from even sitting, and may also be accompanied by fever. The use of powerful painkillers is required, and the use of broad-spectrum antibiotics must be started. Antibiotics do not work properly until the abscessed cavity is drained.

A surgical intervention consists of drainage and surgical cleaning of the abscessed cavity. Surgical treatment; It is done by connecting both holes, internal and external, either respecting the sphincter or cutting it. Other procedures are performed in stages such as Setton, with the intention of reducing the possibility of significant sphincter injury causing fecal incontinence.

Hemorrhoids

The Hemorrhoids are venous dilations packages that are located in the rectum and anus. These are divided into internal, those that are above the dentate line in the anal canal, and external those that are below the dentate line.

Causes

Some causes that predispose to hemorrhoids are hereditary factors, constipation, standing or sitting for a long time, pregnancy , hypertension and obesity .

External hemorrhoids can become thrombosed, which is when a clot forms inside them. Thrombosis is very painful the first days, so it is important to consult a doctor to rule out any complications and to be able to start an adequate treatment.

Internal hemorrhoids are classified into four grades. Those of the first degree are those that when defecating there is only asymptomatic bleeding. Those of the second degree are those that stand out when defecating but are reintroduced when stopping the effort. Those of the third degree are the veins that come out when defecating and must be reintroduced manually. Finally, the fourth grade are irreducible and are always prolapsed.

Other symptoms may be pain, discharge from the mucosa , itching, feeling of a protrusion coming out of the rectum and incontinence.

Treatments

If you have symptomatic hemorrhoids, some measures to treat them are: correct constipation by increasing fiber and fluid; avoid highly seasoned, spicy and fatty foods as well as alcohol consumption ; avoid efforts when defecating; reduce defecation time; use soft toilet paper or anal cleaning by bathing in warm water; Sitz baths with warm water .

Surgical treatment should be performed after a medical analysis based on the state of the disease and the patient. There are everything from non-invasive alternatives, such as elastic ligation, to hemorrhoidectomy .

Among surgical options, classic hemorrhoidectomy is the most common procedure and involves surgical removal of protruding or bleeding tissue. It is a procedure most often outpatient or with a short hospital stay. Most of the time it produces moderate pain that can be treated with pain relievers.

Other options are laser hemorrhoidectomy, cryotherapy, or the use of a stapler specially designed to treat advanced hemorrhoids. This last procedure has the advantage of less postoperative pain, with an efficacy similar to that of classic hemorrhoidectomy.

Diverticular disease

Diverticular disease occurs mainly in patients over the age of 50 and is characterized by inflammation of the “diverticula” which are small saccular formations located in the wall of the colon. These diverticula usually do not cause symptoms, except when they are complicated (inflammation, hemorrhage, or perforation).

When diverticular inflammation occurs, the patient presents with abdominal pain, mainly on the left side, along with fever , nausea and, occasionally, vomiting . Colon diverticula do not require treatment without causing symptoms. Treatment of complications can range from management with a regimen along with antibiotics to surgical intervention, which in recent years has been performed using laparoscopy .

  • Colorectal cancer

Colon cancer is the second and seventh leading cause of cancer death in Panama and Chile , respectively, being a pathology that has been on the rise in recent years. It has different ways of manifesting itself as having bloody stools , abdominal pain, weight loss or as chronic anemia . When a cancer is suspected, a colonoscopy should be performed, which confirms the diagnosis. Treatment is surgery performing resection of the compromised colon segment either traditionally or laparoscopically. In recent years, great advances have been made in the management of colon cancer, making earlier diagnoses and with that a better prognosis for patients.

Related specialties

  • Colon and rectal surgery specialty

This specialist diagnoses and gives medical and / or surgical treatment to patients with pathologies of the colon, rectum and anus. Likewise, the surgeon of this specialty is able to solve other surgical pathologies since it is a requirement to previously study the specialty of general surgery.

  • General Surgery

It is the branch of Medicine that is responsible for diagnosing and treating diseases that require a surgical procedure. During the training period in this specialty, skills are acquired for the management of diseases of the colon, rectum and anus, although these may be insufficient.

  • Gastroenterology

It is the branch of medicine in charge of the diagnosis and treatment specifically of gastrointestinal diseases. In most of the training centers in the world of this specialty, the programs focus on medical treatment with interventional digestive endoscopy procedures.

 

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