Diseases in the region of Rectum and Anal Canal are very much common throughout the world. The dilemma in our set up in particular is that these diseases are often misdiagnosed. This is even more true, in case of females. The reason is that people don’t want to share their problem to the relevant doctors.

Among a number of diseases, under this heading, piles, fissure and fistula are more common, but cancer of Rectum and Anal Canal is also not uncommon, which gives similar symptoms in early stage of cancer.   Unfortunately, all these diseases are taken as piles, which no doubt is commonest of all above conditions. 

A patient is suffering from which one of above diseases, can only be diagnosed, when patient consults a qualified doctor, and most relevant doctor in this regard is a general surgeon, who can make exact diagnosis after examining the patient, which includes, very simple digital rectal examination and examination by a small instrument called proctoscope, which don’t require any anaesthesia and can be done as OPD case.   Knowing that surgeon Will do anorectal examination, which people in general and ladies in particular try to avoid, they prefer to go to non relevant clinicians, even quacks, who without examining the patient label all such diseases to be piles. 

Now if patient actually has piles, he or she may get relief but otherwise disease will go on progressing and get worsened.  This specially leads to a horrible outcome, in case patient is having a cancer of this region.   Even if patient doesn’t have cancer and have benign disease like piles, fissure or fistula, it’s treatment usually is simple in early stage which may not necessarily be surgery.  

Piles usually presents with bleeding per rectum, which is usually fresh and pink in colour, it may or may not be associated with prolapse from anal verge.  The treatment of piles depends upon it’s degree. Piles are now divided in  four degrees.  Degree is established after examining the patient. First degree piles can be treated by dietary measures, simple drugs or by injecting piles, which doesn’t require any anaesthesia or admission of patient in hospital. 

Second degree piles can often be treated non surgically but at times require surgery. Third and fourth degree piles usually require some sort of surgical treatment.   Among a number of procedures by which piles can be treated, a few common procedures include,   injection sclerotherapy, rubber band ligation, laser ablation, and conventional gold standard operative therapy. 

A surgeon can also treat piles using  a particular type of ultrasound probe, although this procedure is also done under anaesthesia, but the  advantage of this method is that there is no wound, so patient recovers quickly. 

Now which method is suitable for a particular patient depends upon stage of disease and final decision will be made after joint discussion between surgeon and patient.  

Fissure-in-Ano presents with severe pain particularly during and for a variable period following defecation. 

Fissure when new can often be treated with drugs, but once it becomes chronic, it requires a very simple procedure carried out under anaesthesia and agony of patient is gone forever. 

A Fistula-in-Ano presents with a lesion around anal verge, which discharges pus, blood or mixed secretions off and on. Fistula in this region  often follows formation of pus in perianal region, which was often ignored by patient. 

Its only treatment is surgery but if patient keeps on ignoring, Fistula-in-Ano can get complicated. 

A fistula is basically a tract whose one end is external which is visible and can be felt by patient, but other end is internal and can only be felt by surgeon and confirmed either during surgery or has to be outlined by special tests like fistulogram, Endoanal ultrasound or MRI. 

The fistula of this region becomes much troublesome, once it’s internal opening lies above the muscles, which are responsible for maintenance of continence.  Sometimes tract has many ramifications in addition to it’s primary course. 

The surgical treatment of Fistula-in-Ano, should be carried out well in time to arrest the progress of disease, otherwise once these complications develop, it’s  surgery can become a lengthy or staged process, at times temporarily diversion colostomy may be needed, which means that for about three months patient will not be able to pass stools through it’s normal passage, rather it will be collected in a bag attached to abdominal surface. An interesting thing about all above conditions is that, these all have episodic course, so, the symptoms will stay for a couple of days and then get remission, that’s the reason, why people come to surgeon after a long time. 

This comes out to be a disaster, if patient was having cancer, because in this modern era, even cancer can be cured , provided it is detected and treated well in time.  Main symptoms when patient has cancer include, bleeding per Rectum, change in bowel habit, discharge of mucus along with faeces, no response to ordinary treatment and weight loss.  Advice to general public is that if they have any problem of anorectal region, they must consult a qualified surgeon and seek advise well in time.  As this is an era of minimally invasive surgery, one might get his or her disease treated without conventional surgery or by minimal invasion.  Moreover these days a number of lady surgeons are also available, so ladies who don’t want to go to male surgeon, can go to a female surgeon as well.      

 

-The writer is consultant laparoscopic 

and general surgeon