Is It Hemorrhoids or Something Worse?

Medically reviewed by Dr. Lauren R. Wilson.

When Charlie’s Angels star Farrah Fawcett died of anal cancer in 2009, it put a spotlight on a disease that isn’t talked about much but has early symptoms similar to everyday hemorrhoids. Understanding the risk factors and the differences between anal cancer and hemorrhoids is critical to staying healthy. Here’s what you should know.

What are hemorrhoids?

Hemorrhoids, also called piles, are a normal part of a person’s anatomy and are part of normal bowel continence or control. What people commonly think of as hemorrhoids are actually symptomatic hemorrhoids that have become inflamed, causing bleeding, prolapse of tissue, pain and itching. These symptoms develop when the blood vessels in the rectum or anal canal become swollen. This swelling is usually the result of increased pressure from straining with bowel movements or actions that increase pressure in the perineum (the area between the anus and the genitals), such as childbirth and heavy lifting. There are two types of hemorrhoids: internal and external. Internal hemorrhoids are in the inner lining of the anus and lower rectum. External hemorrhoids are covered by the skin around the anus.

What are known causes and risk factors for hemorrhoids?

Doctors point to a variety of causes and factors for developing symptomatic hemorrhoids, including:

• Straining during a bowel movement
• Sitting on the toilet for a long period of time
• Chronic constipation or diarrhea
• A low-fiber diet
• Obesity
• Pregnancy
• Being over 50 years of age
• Lifting heavy objects
• Weakening of the tissues around the anus due to aging

What are the symptoms of hemorrhoids?

Hemorrhoid symptoms can vary depending on the type of hemorrhoids you have. For example, internal hemorrhoids inside the rectum usually can’t be seen or felt because they’re deep inside. However, you might see blood in your stool, on tissue or in the toilet bowl. You might also experience a hemorrhoid that has pushed through the anus (a prolapsed hemorrhoid), which can cause discomfort.

With external hemorrhoids, you’re most likely to experience anal itching; swelling or lumps around the anus; rectal bleeding; and pain around the anal area, especially when sitting. Some people will experience a clot in an external hemorrhoidal vessel that can be very painful.

When should you see your doctor?

We spoke with Dr. Lauren R. Wilson, a specialist in colorectal surgery and assistant professor of surgery at Dartmouth-Hitchcock Medical Center for her input.

“If you’re having any kind of issue with your bottom, go see your primary care doctor and ask them to take a look. Rectal exams used to be part of an annual physical, but a lot of doctors just don’t do them anymore. You need to be open to having an exam and ask them about it.”

How are hemorrhoids diagnosed and treated?

Your doctor can typically diagnose hemorrhoids on sight, especially if you have external hemorrhoids, or through internal examination with a finger and anoscope. They can often be easily treated by avoiding straining, increasing dietary fiber (often with a fiber supplement), and topical over-the-counter medication or home remedies, including sitting in a warm bath to help reduce swelling and inflammation. Pain relievers (acetaminophen, aspirin, ibuprofen) can also help to reduce discomfort. Symptoms usually go away within a few weeks. If you have persistent symptoms, your doctor might recommend a colonoscopy to rule out any other problems in your GI tract, and then office-based procedures or surgery.

What you need to remember is that if pain and bleeding persist, or are associated with pelvic pain and a fever, it’s time to see your doctor to rule out any other issues such as gastrointestinal diseases, infections or anal cancer, which share similar symptoms.

What is anal cancer?

Anal cancer is a rare form of cancer that occurs within the anal canal, where normal cells mutate, become abnormal and multiply, forming tumors. These tumors invade nearby tissue and can separate and spread to different parts of the body, especially to the lymph nodes, lungs and liver.

Anal cancer is rare, representing only around 0.5% of all new cancer cases reported each year, or nearly 8,600 people (as compared with 277,000 new breast cancer cases). On average, 86,000 Americans are living with anal cancer annually, and the five-year survival rate for anal cancer is approximately 70%.

What are known causes and risk factors for anal cancer?

As with most cancers, there are multiple causes and risk factors for anal cancer. One significant correlation to note is the sexually transmitted human papillomavirus (HPV), which is a common viral infection. Roughly 85% of women and 91% of men will get HPV by the time they are 45. Detected in the majority of anal cancer cases, HPV is considered a major factor in causing anal cancer (as well as cervical cancer and cancers of the vagina, vulva, penis and throat). The HPV vaccine has been effective in reducing rates of infection and reducing rates of certain types of cancer.

Other risk factors include:

• Having many sexual partners over a lifetime
• Engaging in anal sex
• A history of HPV-associated cancer, including cervical, vulvar or vaginal cancer
• Being over 50
• Being HIV-positive
• Smoking
• Taking medications that suppress the immune system (being immunocompromised)

What are the symptoms of anal cancer?

The most common first sign of anal cancer is rectal bleeding, which is why it’s a cause for concern for those with hemorrhoids. Other symptoms that are similar to hemorrhoids include pain around the rectum or anus, anal itching, and a mass or growth in the anal canal.

However, there are other symptoms of anal cancer that are distinct and should be given special attention. They include:

• A feeling of fullness around the anal area
• Abnormal discharge from the anus
• Narrow stools or changes in bowel movements
• Fecal incontinence
• Swollen lymph nodes in the groin or anal area

Can anal cancer be caught early?

Anal cancer can be caught early. “It really depends on how much someone pays attention to their symptoms,” Wilson said. “Too often people keep putting off seeing their doctor while assuming their symptoms are just hemorrhoids.”

How is anal cancer diagnosed and treated?

Most anal cancers are discovered because of patient symptoms. Your doctor might do a digital rectal exam and a pelvic exam with a Pap test, or could also recommend various types of diagnostic scopes, depending on the affected area.

Biopsies are also usually taken of any polyps or unusual growths. Once anal cancer is diagnosed, additional testing with imaging studies is performed to look for spread of the disease and establish a stage. Depending on the stage of the disease, most cases are treated with a combination of chemotherapy and radiation. However, depending on symptoms or if these treatments aren’t effective, surgery may be recommended.

What’s the takeaway?

Even while anal cancer is rare, experts including Wilson emphasize seeing your doctor at the first sign of any problems, especially bleeding. Most patients assume “it’s just hemorrhoids,” but the majority of patients presenting with symptoms in the anal or rectal area have a diagnosis other than symptomatic hemorrhoids. Sometimes it’s an infection or a tear in the lining of the anal canal called an anal fissure, and sometimes it’s cancer. With careful evaluation and testing, your doctor can make a diagnosis, recommend appropriate treatments, and get you feeling better. And if it turns out your symptoms are from cancer, early detection is key to a positive outcome.

Resources:

Anal Cancer Foundation

American Society of Colon and Rectal Surgeons — Tips for Patients

Top Signs You May Have a Hernia: Ira Klonsky, MD: General Surgeon

When you have a hernia, you have an organ or tissue pushing through a weakened part of your abdominal wall that should be holding it in place. Several types of hernias can develop in various parts of your abdomen, including the: 

• Groin
• Upper stomach
• Pelvic floor
• Bellybutton

You can also develop hernias around surgical incisions.

Many hernias don’t cause any symptoms and aren’t life-threatening. However, some untreated hernias can be dangerous and require immediate attention. So, when symptoms do arise, don’t ignore them. 

As a hernia specialist at South Shore Surgical in Valley Stream, New York, Dr. Ira Klonsky recommends watching for these signs that could indicate a hernia.

A strange bump or lump

One of the most common signs of a hernia involves protruding tissue that you can’t push back into place. These bumps often appear in the abdomen, groin, or on either side of the pubic bone. 

Hernia bumps can be painless or severely painful, and they can vary in size. It’s also common for them to grow bigger or smaller when the pressure in your abdomen changes, especially when you’re coughing, standing, or lying down.

Discomfort or pain

If you have pain while lifting or when bending over, it could be a hernia. Other signs of hernia discomfort include:

• Burning
• Aching
• Stabbing 
• Pressure
• Weakness

You can also develop a hernia while lifting something heavy, which often causes a sharp, tearing, or searing pain.  

Nausea or vomiting

Most people don’t associate nausea and vomiting with hernias, but these symptoms can indicate a serious problem known as an incarcerated hernia. In these cases, herniated tissue gets trapped, which can trigger bowel obstruction, tissue strangulation, and life-threatening complications. 

Constipation or feelings of fullness

If you’ve been struggling with constipation, problems passing gas, or feel like you’ve had an enormous meal even when you haven’t, it could be an inguinal hernia. These common hernias make up 75% of all abdominal wall hernias and usually occur up to 25 times more often in men. 

When you have an inguinal hernia, it often occurs with pain in the lower abdomen or groin.

Acid reflux or heartburn

It’s easy to assume that heartburn symptoms are due to something you ate, but hiatal hernias can also cause them. These common hernias develop in the upper part of your stomach and bulge through your diaphragm.  

When you have a small hiatal hernia, you may not have any symptoms at all. But as they grow larger, these hernias can cause acid and food to flow back into your esophagus, causing esophageal inflammation and digestive symptoms like heartburn.

Treating a hernia

If you have a hernia, Dr. Klonsky can perform surgery to repair the area using advanced laparoscopic techniques such as robotic technology. This minimally invasive approach comes with fewer risks and faster recovery times, and you can usually go home the same day.

To learn more about hernia treatment in Greater Queens, Long Island, and the surrounding communities in New York, contact South Shore Surgical’s Valley Stream office today by calling or requesting an appointment online today. You can also send a message to Dr. Klonsky and the team here on the website.

Perineum Pain: Symptoms, Causes & Treatment

What is Perineum Pain?

The perineum is a major area of muscle attachment, which makes it one of the most common sites of pain. Perineum pain can affect any man or woman. The perineal region includes the space between the genitals and anus. Pain can occur in the perineum because of nearby organs, muscles, and nerves.

All Sexes

Anyone of any gender can experience perineum pain. The pain can result from injury, infection, or other health conditions such as diabetes. Individuals of any age can feel perineum pain.

Men

In males, the perineum is the space between the scrotum and anus. A swollen or inflamed prostate can lead to perineum pain in men.

Women

In women, the perineum is the space between the vaginal opening and anus. Women are particularly vulnerable to perineum pain because of childbirth and urinary tract infections. Perineum pain in women can also feel sore and itchy.

Signs and Symptoms

There are several common perineum pain symptoms. Some of these symptoms are the same for both men and women. For example, both men and women may experience a burning sensation in the perineum, as well as lower abdominal pain. Genital pain, anal pain, pelvic pain, and lower back pain are all common among all genders. Men and women might also experience pain when sitting.

Women will often also have additional symptoms of vaginal discharge or painful urination due to these conditions. Women can experience burning, soreness, and itchy perineum pain. Sexual pain during intercourse, during orgasm, and after sex can also occur.

Perineum pain symptoms in men include bladder pain, more frequent urination, and tailbone pain.

Causes

The cause of perineum pain can differ between men and women. However, some perineum pain causes remain the same across genders.

All Sexes

The following conditions can cause perineum pain in men and women:

• Injuries — Minor injuries to the groin can cause perineum pain. Injuries can occur from falls, accidents, or strikes to the groin.
• Pelvic floor dysfunction — Pelvic floor dysfunction happens when your pelvic muscles are not working properly. Experts are not entirely sure why this happens. They suspect that something weakened or tore your muscles such as having a baby or surgery in the pelvic area.
• Hemorrhoids — Hemorrhoids can cause perineum pain. Hemorrhoids are varicose veins in the anus or rectum. They usually develop because of increased pressure and straining while passing stool, pregnancy, or heavy lifting.
• Interstitial cystitis — Interstitial cystitis is a long-lasting condition that can cause pain and pressure in your bladder. Perineum pain can occur because of a malfunction of your pelvic nerves. Your body tells you that you need to urinate all day and night even though your bladder is not full.
• Pudendal nerve entrapment — This is nerve damage in your pelvis. Surrounding muscle or tissue compresses the nerve, causing pain.
• Abscess — An abscess is a medical condition in which bacteria and other infection-causing agents propagate to create an irritating pouch of pus. An abscess can form on your perineum or in a nearby area.
• Urinary Tract Infections (UTIs) — A urinary tract infection is an infection that happens in any part of your urinary system, such as the urethra or bladder. Most UTIs affect the lower urinary tract. UTIs develop when bacteria infiltrate your body through your urethra and cause an infection in this region.

Men

Prostatitis is pain and inflammation of the prostate gland. It can be acute or chronic, but it is usually a temporary problem that resolves within six weeks to two years. Pain may range from mild discomfort to severe agony, often worsening at nighttime. Other symptoms include difficulty urinating (dribbling urine), painful ejaculation or orgasm, and frequent waking up at night to urinate. Prostatitis can also cause perineum pain in men.

Women

There are several causes of perineum pain specific to females:

• Childbirth — Childbirth can cause pelvic floor dysfunction that leads to perineum pain during sex. During childbirth, your doctor may perform an episiotomy by making a small incision to the perineum. This allows more room for the baby to move through the birth canal. The perineum might also tear during delivery.
• Vulvodynia — Vulvodynia is a condition in which the vulva (clitoris, labia minora and majora) hurt without any obvious reasons. Vulvar pain may be caused by localized injury, such as from sexual intercourse or wearing tight clothes.

Diagnosis

Perineum pain diagnoses involves a routine medical exam, a discussion of your symptoms, and other medical tests. The specific test your doctor performs depends on the underlying medical problem they suspect. There are many possible reasons for perineum pain in men and perineum pain in women.

Common diagnostic tests include:

• Blood tests — Blood tests will tell doctors if there is a problem with your blood that is causing pain in the perineum. Your doctor will usually check for infections and analyze your blood cell count.
• Urinalysis — A urinalysis will tell doctors if you have a urinary tract infection.
• Radiological evaluation or ultrasound — These tests allow doctors to see if there is an abnormality such as a tumor, cyst, or other mass that may be causing your pain.

Treatment

Perineum pain treatment varies based on the underlying condition causing the pain. Perineum pain female treatment is sometimes different than perineum pain male treatment.

The most common treatment is rest. Rest allows the body to repair any damage and heal itself. Antibiotics can also help heal certain types of perineum pain. Perineal massage is a type of physical therapy that can help with pelvic pain, but it should be postponed until any inflammation subsides.

Perineal massage can be used to help alleviate pain due to hemorrhoids, constipation, perineum tearing, anal fissures, and other conditions.

Perineal pads, also called sanitary napkins, are sometimes used to protect underwear from blood after giving birth, when having difficulty controlling bowel movements, or to protect a wound to the perineum.

Pelvic Floor Dysfunction Expanded Version

Pelvic floor dysfunction includes a group of disorders causing abnormalities of bowel storage and bowel emptying, as well as pelvic pain.   This information is intended to help patients gain a better understanding of the disorders making up pelvic floor dysfunction, as well as the evaluation and treatment of pelvic floor dysfunction.  It is intended to help patients who suspect that they may have pelvic floor dysfunction better understand the reason for their symptoms, and help them realize that with proper evaluation and treatment it is possible to get relief from symptoms that can be quite disabling.  Patients should know that a thorough, step-wise approach to evaluate their symptoms may offer prompt diagnosis and treatment for what often is a long-standing, frustrating problem.

Pelvic floor dysfunction can be caused by a number of specific conditions.  These include:

• Rectocele
• Paradoxical Puborectalis Contraction
• Pelvic pain syndromes:
  • Levator Syndrome
  • Coccygodynia
  • Proctalgia Fugax
  • Pudendal Neuralgia

WHAT IS THE PELVIC FLOOR?

The pelvic floor is a sheet of muscle through which the rectum passes and becomes the anal canal.   The anal canal is surrounded by the anal sphincter complex, which is comprised of both an internal and external component.   Many of the disorders above are due to improper functioning of the pelvic floor muscles.  The levator ani muscle (also called the pelvic diaphragm) is the major component of the pelvic floor.  The levator ani muscle is actually a pair of symmetrical muscular sheets comprised of 3 individual muscles – the iliococygeus, pubococcygeus, and puborectalis.   The puborectalis is a U-shaped muscle that attaches to the pubic tubercle (“the pubic bone”) and wraps around the rectum – under normal circumstance, this muscle is contracted, maintaining a “bend” in the rectum and contributing to stool continence.  The act of bearing down to pass a bowel movement typically causes this muscle to relax, allowing the rectum to straighten.   In addition to the rectum, the urethra, which carries urine from the bladder to the outside of the body, also passes through the front portion of the pelvic floor, as does the vagina in females.

Legend:  This image shows a view of the pelvic floor muscles from above.  The image on the right shows the relationship of the rectum as it passes through the pelvic floor and becomes the anus, surrounded by the anal sphincter complex.

ASCRS Textbook 2nd edition, pages 11 and 3.

HOW IS PELVIC FLOOR DYSFUNCTION EVALUATED?

As many components of evaluation are quite similar in pelvic floor dysfunction, we’ll discuss the methods used to evaluate these disorders prior to discussing each disorder separately.   The most important part of evaluating a patient with suspected pelvic floor dysfunction is a thorough medical history and physical examination, including an examination of the pelvic floor.  An important aspect of the history includes a thorough obstetrical (child-bearing) history in women.  This should seek to identify a history of difficult deliveries, forceps deliveries, prolonged labor, and traumatic tears or episiotomies (controlled surgical incision between the rectum and vagina to prevent traumatic tearing during childbirth).  A thorough history of the patient’s bowel patterns, including diarrhea, constipation, or both, is also essential. Other key parts of the history include prior anorectal surgeries and the presence of absence of pain prior to, during, or following a bowel movement.

After a complete history and physical examination, a number of tests may be performed, depending on the patient’s symptoms and the physician’s suspicion of what may be causing the symptoms.   These tests can sometimes be uncomfortable or somewhat embarrassing for the patient, but can provide valuable information to help determine what is causing the patient’s symptoms and help provide some relief.  

ENDOANAL/ENDORECTAL ULTRASOUND:

This test uses sound waves to create anatomic pictures of the anus and its surrounding sphincter muscles and the wall of the rectum. It typically involves the insertion of a slender ultrasound probe that is generally no bigger in diameter than an index finger into the anus and/or rectum.  You are usually asked to perform an enema prior to the procedure to empty the anus and rectum.  Sedation is generally not given.  The procedure usually takes just a few minutes and is generally associated with only minor discomfort.

ANORECTAL MANOMETRY TESTING:

This test provides the physician with information regarding how well the anal sphincter muscles squeeze at rest and with voluntary attempts to squeeze the muscle.   It also helps determine how effective the sensation of the anus and rectum is.  The compliance (distensibility) of the rectal wall can be determined.  The sensation and compliance results can provide important information explaining how the rectum responds to stool entering the rectum (either over- or under-reactive to the presence of the stool). Finally, information about the function of reflexes in the anus and rectum necessary to pass stool can be determined. The test involves placing a small flexible catheter (about the diameter of a pencil) with a small balloon on the end into the rectum.  Similar to the ultrasound test, which is often done at the same setting, no prep is required other than an enema, and the patient is awake during the procedure because he/she must be able to follow commands or indicate when they feel certain sensations.

PRUDENDAL NERVE MOTOR LATENCY TESTING:

This test evaluates the function of the nerves to the pelvic floor and anal sphincters.   It involves stimulation of the pudendal nerve from inside the anus using an electrode on the end of the examiner’s finger.  Stimulation of the nerves causes muscle contraction, which can sometimes be mildly uncomfortable for the patient, and conduction through the nerve is measured to determine whether the nerve is conducting signals to the muscles at a normal rate or if it is delayed.

ELECTROMYOGRAPHY (EMG):

EMG is another means of evaluating the activity of the nerves and muscles of the anal sphincter and pelvic floor.  There are a number of different ways to perform this test – some involve the placement of small needles into the muscles while others utilize a plug that is placed into the anal canal.  It can be a little more uncomfortable for the patient than some of the other tests that have been described, but patients should be reassured by the fact that it can provide valuable information in certain situations.

VIDEO DEFECOGRAPHY:

During this study, the patient is given an enema of thickened liquid (“contrast”) that can be seen on x-rays.   A special type of x-ray machine then takes video pictures while the patient sits on a commode, recording the movement of the muscles of the pelvic floor as the patient evacuates the liquid from the rectum.  As this study very realistically re-creates what happens during an actual bowel movement, it provides valuable information about the coordination of movement of the pelvic muscles that occurs during the process of a bowel movement.  An alternative to the more traditional video defecography is dynamic MRI defecography, in which the images are captured with the use of an MRI rather than regular x-rays.  This is a relatively new procedure that is performed only in selected centers.

COLONIC TRANSIT STUDY:

This test, which is also sometimes called a Sitz marker study, is valuable in patients with severe constipation in helping to determine whether the cause of constipation is due to a problem with ineffective contraction of the colon or due to a problem with passage of stool through the pelvis.   To perform this test, a small gelatin capsule containing small rings that will appear on an x-ray is swallowed.

Once swallowed, the capsule dissolves and the rings are released into the intestinal tract.   X-rays of the abdomen are then taken at defined periods of time (for example, on days 1, 3, and 5 or on days 2 and 5) and the movement of the rings through the colon is tracked.   Most of the rings should have passed out of the body in bowel movements by day 5.  If not, the number and pattern/location of the remaining rings is noted on the x-ray.  If the rings remain together at the beginning of the colon or scattered throughout the entire colon, it is thought to mean that there is a problem with overall colon motility.  If the remaining rings are clustered near the end of the colon or rectum, it may mean that some sort of pelvic floor outlet obstruction may be causing the constipation.

BALLOON EXPULSION TEST:

This test involves the placement of a small rubber balloon into the rectum, which is then filled with water.   The patient is then asked to sit on a commode or toilet and expel the balloon.  Most patients should be able to expel the balloon in under a minute.  Failure to do so may indicate some degree of obstructed defecation.

PELVIC FLOOR DYSFUNCTION: DISORDERS

RECTOCELE

WHAT IS A RECTOCELE?

The vagina and the rectum can be thought of as two muscular tubes running parallel to each other and sharing a common muscular wall between them – the back wall of the vagina and the front wall of the rectum together make up what is called the “rectovaginal septum”.  A rectocele occurs when the rectovaginal septum becomes weak and the rectum bulges forwards into the vagina. 

Rectocele Diagram Courtesy of Robin Noel

Hospital of the University of Pennsylvania

Department of Surgery

4th Floor Maloney Building, Fitts Education Center

Philadelphia, PA 19104

215-349-5043
www. uphs.upenn.edu/surgery/

www.uphs.upenn.edu/surgery/admin/noel.html

The finding of a small rectocele on examination is very common and is of no concern if the patient does not have significant symptoms. When a rectocele becomes large, stool can become trapped within it, making it difficult to have a bowel movement or creating a sensation of incomplete evacuation.  Symptoms are usually due to stool trapping, difficulty passing stool, and protrusion of the back of the vagina through the vaginal opening.  During bowel movements, women with large, symptomatic rectoceles may describe the need to put their fingers into their vagina and push back toward the rectum to allow the stool to pass (“splinting”). Rectoceles are more common in women who have delivered children vaginally. 

HOW IS A RECTOCELE DIAGNOSED?

Often, a rectocele is easily recognized on physical examination at rest or with performance of various maneuvers.   In instances of very large rectoceles, the back wall of the vagina may bulge out beyond the opening of the vagina. Smaller rectoceles may only be obvious when the woman strains. Video defecography can be useful in the diagnosis of a rectocele.   In the presence of a rectocele, the contrast material can be seen bulging from the front of the rectum into the back of the vagina.  Sometimes the contrast material stays in the rectocele while the liquid in the rectum is expelled — this is called “stasis”, or stool trapping.

HOW IS A RECTOCELE TREATED?

In the absence of severe symptoms, the recommended treatment for a rectocele is non-surgical, and focused on optimizing stool consistency to aid in the passage of stool.  This often involves increasing fiber intake (which may also include taking a daily fiber supplement) and increasing fluid intake.  Biofeedback, which is a special form of pelvic floor physical therapy aimed at improving a patient’s rectal sensation and pelvic floor muscle contraction, may also be helpful.   As described above, the patient may insert one or two fingers into the vagina to splint the vagina during attempts to pass stool.

When symptoms persist despite appropriate non-surgical measures, surgical treatment may be considered.  This usually involves reinforcement of the rectovaginal septum, using either an approach through the rectum (as favored by most colon and rectal surgeons) or through the vagina (as favored by most gynecologists).  Some surgeons have recently begun utilizing a technique called the STARR (stapled transanal rectal resection) procedure, in which a surgical stapling device is used to remove a portion of the rectocele.  This is a newer procedure that is not performed by all colon and rectal surgeons, and its success and complication rates are still being studied.

PARADOXICAL (NON-RELAXING) PUBORECTALIS SYNDROME:

WHAT IS PARADOXICAL (NON-RELAXING) PUBORECTALIS SYNDROME?

The puborectalis muscle is a muscular sling that wraps around the lower rectum as it passes through the pelvic floor.   It serves an important role in helping to maintain fecal continence and also has an important function during the act of having a bowel movement.  At “rest,” the puborectalis is contracted and pulls the rectum forward; creating a sharp angle in the rectum that helps to prevent passive leakage of stool.  During the normal process of defecation, as one bears down to pass stool, the puborectalis reflexively relaxes and straightens out, allowing stool to pass more easily through the rectum into the anal canal.  Paradoxical puborectalis syndrome occurs when the muscle does not relax when one bears down to pass stool. In some cases, it actually contracts harder, creating an even sharper angle in the rectum, resulting in difficulty emptying the rectum, a term sometimes referred to as obstructed defecation.  Patients often complain of the sensation of “pushing against a closed door”.  Often, there is a history of needing to use an enema to have a bowel movement.  Generally, there is no associated rectal pain or discomfort, which helps distinguish it from other pelvic floor syndromes.   The exact cause is unclear, but it is thought to be due to a combination of factors that may include improper functioning of the nerves and/or muscles of the pelvic floor.  Psychological mechanisms may also play a role.

HOW IS PARADOXICAL (NON-RELAXING) PUBORECTALIS SYNDROME DIAGNOSED?

This condition is usually diagnosed by a combination of longstanding difficulty passing bowel movements along with various testing modalities, including manometry, EMG, and defecography.  These would demonstrate the puborectalis muscle not relaxing during the act of having a bowel movement. Patients will often have an abnormal balloon expulsion test, as well. 

HOW IS PARADOXICAL (NON-RELAXING) PUBORECTALIS SYNDROME TREATED?

The management of paradoxical (non-relaxing) puborectalis syndrome is largely non-surgical.  The mainstay of treatment is biofeedback therapy.  As patients perform this specialized form of pelvic floor physical therapy, they are often able to view EMG or manometry tracings produced by a sensor in the rectum so that they can actually visualize the results of their efforts to relax the pelvic floor.   Portable units have even been developed for home use.   The success rate of biofeedback for this condition ranges from 40-90%, and most failures are due to the patient not keeping up with their exercises or performing them incorrectly. The implantation of a sacral nerve stimulator to modulate the input from the nerves to the muscles of the pelvic floor has been shown to be effective in some instances, with success rates as high as 85% in carefully selected patients.  For severe cases where these methods fail, surgical creation of a colostomy, through which the patient passes stool into a bag on the abdominal wall, may be a last option, though this is very rarely required.

PELVIC PAIN SYNDROMES

Chronic pelvic pain can be seen in up to 11% of men and 12% of women, and results in 10% of the total visits to gynecologists.  There are a number of types of pelvic pain syndromes, which will be discussed further. 

LEVATOR SYNDROME:

WHAT IS LEVATOR SYNDROME?

Patients with levator syndrome experience episodic pain, pressure, or discomfort in the rectum, sacrum (lowest part of the spine), or coccyx (tailbone) associated with pain in the gluteal region and thighs.   The pain is often described as a vague, dull, or achy pressure sensation high in the rectum that may be worse with sitting or lying down.  The pain comes and goes and may last for hours or days.  The exact cause is not known, but anxiety and depression have been closely associated with levator syndrome.

HOW IS LEVATOR SYNDROME DIAGNOSED?

There is no test that will definitively confirm the diagnosis of levator syndrome.  It is often considered a “diagnosis of exclusion,” meaning that care must be taken to rule out other causes of pain before making a diagnosis of levator syndrome.  Patients often will experience similar discomfort during a digital rectal examination when the examiner’s finger places traction on the puborectalis muscle. 

HOW IS LEVATOR SYNDROME TREATED?

A number of methods of treatment are available for levator syndrome.  Physical therapy, including digital massage of the puborectalis with a combination of heat and muscle relaxants, has been shown to be effective in reducing symptoms in up to 90% of patients.   Injection of local anesthetics and anti-inflammatory agents into the puborectalis muscle can provide relief, though the results are often inconsistent and short-lived.  Electrical stimulation of the pelvic floor muscles using a probe in the rectum has also been used – although the results with this are extremely variable.  Biofeedback therapy has been used with excellent results in terms of relieving discomfort.  A newer modality that is being investigated is sacral nerve stimulation.  This procedure, which is more commonly used to treat fecal and urinary incontinence, involves the placement of electrodes that stimulate the nerves to the pelvis. 

COCCYGODYNIA:

WHAT IS COCCYGODYNIA?

Coccygodynia may often be part of a group of pelvic floor symptoms, but it is distinguished by distinct pain that is evoked with pressure or manipulation of the coccyx or tailbone.  It is usually due to a history of trauma to the tailbone, but other causes include weakening of the tailbone due to poor blood flow (avascular necrosis) and referred pain from herniated lumbar disc.

HOW IS COCCYGODYNIA DIAGNOSED?

It usually is diagnosed by a combination of history and physical examination.  X-rays should be done to rule out either a recent or longstanding fracture of the tailbone. 

HOW IS COCCYGODYNIA TREATED?

Surgical excision of the tailbone (coccygectomy) was once popular, but now is rarely performed as the initial means of treatment.  Injection of local anesthetics and anti-inflammatory agents with manipulation of tailbone under anesthesia can provide relief from pain in up to 85% of patients.  Coccygectomy may be considered for those who fail injection therapy.

PROCTALGIO FUGAX:

WHAT IS PROCTALGIA FUGAX?

Proctalgia fugax is characterized by fleeting pain in the rectum that lasts for just a minute or two.  Because the pain comes and goes quickly and unpredictably, it is difficult to evaluate.   It is thought that it is probably due to spasm of the rectum and/or the muscles of the pelvic floor and often wakes patients from sleep.

HOW IS PROCTALGIA FUGAX DIAGNOSED?

Proctalgia fugax may be diagnosed after a careful history and examination and thorough evaluation have been performed to rule out more serious causes of rectal pain.

HOW IS PROCTALGIA FUGAX TREATED?

Muscle relaxants may provide some relief from the intermittent discomfort associated with proctalgia fugax.  The patient should be otherwise reassured that the symptoms are not a sign of another more serious disorder.

PUDENDAL NEURALGIA:

WHAT IS PUDENDAL NEURALGIA?

Pudendal neuralgia is characterized by chronic pain in pelvis and/or the perineum in the distribution of the pudendal nerves, which are the main sensory nerves of the pelvis.  It may present as pain in the vulva, testicles, rectum, or prostate.   It may also cause problems with defecation.  Usually it is due to entrapment of the nerve(s) by pelvic muscles and sometimes is made better or worse by changes in position.  It may occur after pelvic trauma and is also common in those with chronic, repetitive trauma to the perineum, such as cyclers and rowers.

HOW IS PUDENDAL NEURALGIA DIAGNOSED?

Typically, pain may be exacerbated during digital rectal examination when direct pressure is placed on the pudendal nerve through the rectal wall.  If nerve testing is performed, slow conduction of impulses through the nerves may be seen.  As is the case with the other pelvic pain syndromes, a careful evaluation must be performed to exclude other, more serious, etiologies for the pain.

HOW IS PUDENDAL NEURALGIA TREATED?

Reassurance from the physician should be provided to alleviate patient fears that a more serious condition is present.  Initial management usually consists of a combination of either oral or injected anti-inflammatory agents, physical therapy, and muscle relaxants.   A nerve block may provide temporary relief in patients who don’t respond to initial conservative means of treatment.  Surgical decompression of entrapped nerves may be considered only in severe, refractory cases.

WHAT IF I CHOOSE TO DO NOTHING ABOUT MY PELVIC FLOOR DYSFUNCTION?   

The decision not to undergo treatment for pelvic floor dysfunction is one that should be made only after the patient has undergone a thorough evaluation by a physician who is experienced in evaluating and treating these disorders.  Especially when dealing with the pelvic pain syndromes, a thorough evaluation must be performed to exclude a more serious condition, such as rectal cancer or anal cancer.  Fortunately, the conditions described above are not life-threatening.  Also, most of them are initially managed with non-surgical means, meaning patients are typically more willing to institute a treatment plan.

Should you choose to not undergo treatment, keep in mind that symptoms of pain and discomfort may persist or even progress.   In conditions that cause obstructed defection, the inability to effectively evacuate the colon and rectum may lead to long-term damage to the colon, further exacerbating symptoms of constipation.

QUESTIONS FOR YOUR SURGEON:

1. What are the options for medical management for pelvic floor dysfunction?
2. Do I need a colonoscopy?
3. Do I need surgery?
4. What are my options for surgery?
5. Do I have to go to the operating room for treatment?
6. What options do I have for anesthesia with an operative procedure?
7. What can I expect after surgery?
8. How do you plan to address my pain after surgery?
9. What will happen if I don’t want any treatment?

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum, and anus. They have completed advanced surgical training in the treatment of these diseases, as well as full general surgical training. They are well versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions, if indicated to do so.

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances

presented by the individual patient. 

CITATIONS:

Harford, F.J., Brubaker, L.  “Pelvic Floor Disorders.”  Chapter 49 in Wolff, B. G., Fleshman, J. W., Beck, D. E., Pemberton, J.H., Wexner, S. D., Eds.  The ASCRS Textbook of Colon and Rectal Surgery.  Springer, New York, NY, 2007.

Timmcke, A.  “Functional Anorectal Disorders.” Chapter 7 in Beck, D. E., Wexner, S. D., Eds. Fundamentals of Anorectal Surgery, 2nd Edition.  WB Saunders, London, England, 2002.

Green, S. E., Oliver, G. C.  “Proctalgia Fugax, Levator Syndrome, and Pelvic Pain.”   Chapter 18 in Beck, D. E., Wexner, S. D., Eds. Fundamentals of Anorectal Surgery, 2nd Edition.  WB Saunders, London, England, 2002.

SELECTED READINGS:

http://www.mayoclinic.org/chronic-constipation/

http://my.clevelandclinic.org/disorders/pelvic_disorders/hic_pelvic_floor_dysfunction.aspx

Signs of anal cancer | Ada

What is anal cancer?

Anal cancer is a rare cancer that arises from the anus. The anus is comprised of the anal canal, a passage about 3-4 cm or 1.5 inches and the anal margin, also known as perianal skin, the opening where feces is excreted from the body. Anal cancer refers to several types of cancer that can develop in this area.

The most common symptoms of anal cancer include bleeding from the anus, itching around the anus, and anal pain. Many non-cancerous conditions have similar initial symptoms, such as anal fissure or hemorrhoids.

Anal cancer tends to spread slowly. With early treatment, in many cases, it has a relatively good prognosis.

This condition tends to affect older adults between the ages of 50 and 80, and is slightly more common in women than in men. About 1.8 per 100,000 people in the U.S. are newly diagnosed with anal cancer per year.

Treatment depends on the type of anal cancer and stage of diagnosis, but typically involves a combination of surgery and chemotherapy. Recovery rates tend to be better in cases where the cancer is diagnosed early.

Types of anal cancer

Anal cancers are often divided into two groups, which are sometimes treated differently:

• Cancers of the anal margin: These begin in the cells of the anal margin – the edge of the anus that can be partly seen as darker skin on the outside of the body. They are more common in men and have a relatively good prognosis.
• Cancers of the anal canal: These begin in the cells of the anal canal –the inner part of the anus, connecting the rectum – the final section of the intestine, that connects it to the anus – to the anal margin. They are more common in women and have a relatively worse prognosis.

There are several different types of anal cancer. These include:

Carcinoma in situ

Carcinoma in situ is considered by some doctors to be the earliest form of anal cancer, and by others to be a precancerous condition, which may develop into cancer.

In carcinoma in situ, there are abnormal cells on the surface layer of the anus, which have not spread to any deeper layers.

Squamous cell carcinomas

Squamous cell carcinomas are the most common type of anal cancer, making up 80 or 90 percent of cases. It starts in the squamous cells which form the surface layer of the lining the anal margin and anal canal. This is similar to carcinoma in situ, except that these cancers have grown into the deeper cells and layers of the anal canal, and may spread.

Adenocarcinomas

Adenocarcinomas make up about 15 percent of anal cancers. These may start in glands in the anal area or in the cells that line the part of the anus near the rectum.

Skin cancers

Some anal cancers are basal cell carcinomas or malignant melanomas – two different types of skin cancer. Only a very small portion of anal cancers are skin cancers.

Other types of anal cancer

Other, very rare types of anal cancer include:

• Lymphomas
• Gastrointestinal stromal tumors (GIST)

Anal cancer symptoms

Anal cancer may present with a wide range of symptoms, or may have no symptoms at all. The most common symptoms of anal cancer include:

• Bleeding from the anus
• Anal or pelvic pain
• Anal itching
• Discharge from the anus
• A lump in or near the anus

Less common symptoms may include:

• A change in bowel habits, such as increased gas, losing control of one’s bowel, or hard or soft feces
• Severe or complete constipation
• Swollen lymph nodes in the groin and anal region

Most often these symptoms are more likely to be caused by non-cancerous conditions, such as hemorrhoids, anal fissures, or anal warts. If any of these symptoms are present, it is important to see a doctor quickly so that the cause can be found and treated appropriately.

Anal cancer causes

The causes of anal cancer are not well understood. However, certain factors are thought to increase a person’s risk of developing the condition. It is most commonly linked to human papillomavirus (HPV), a sexually transmitted infection (STI) which more commonly causes genital and anal warts.

Anal cancer risk factors

Factors that may increase the risk of developing anal cancer include:

• Human papillomavirus (HPV)
• A history of cervical or vaginal cancer
• A lowered immune response, such as occurs with HIV or from medication taken after organ transplantation
• Smoking tobacco
• Being over 50
• Receptive anal intercourse
• Repeated inflammation in the anal region

Anal cancer is most common in people between the ages of 50 and 80, and it is slightly more common in women than in men.

Anal cancer diagnosis

Symptoms of anal cancer may be caused by a number of other conditions, including hemorrhoids, anal fissures, or anal warts. A doctor will need to rule these out in the diagnostic process.

Anal cancer tests

As the first step, a doctor will typically take the person’s medical history and perform a physical examination. In addition, a doctor may perform the following tests:

• Digital rectal examination (DRE), which involves inserting a gloved finger into the anus to feel for lumps or other abnormalities.
• Anoscopy may be performed if the doctor feels a suspicious area during DRE. The doctor will insert into the anus a thin, flexible tube with a light and camera on the end called an anoscope, allowing them to see the inside of the anus.
• Biopsy, a procedure to remove a small amount of tissue for examination under a microscope, can make a definite diagnosis. The type of biopsy will depend on the location of the abnormal cells, but may include an excisional biopsy to remove an entire lump.
• Ultrasound, X-ray, computed tomography (CT scan), magnetic resonance imaging (MRI) or positron emission tomography (PET scan) may be used to investigate the size of the cancer.

If any of the results of these tests are positive for cancer, further investigation is done to confirm the staging of the cancer.

Anal cancer screening in people at high risk

Screening is a way of identifying apparently healthy people who may be at an increased risk of a particular condition. This is often done to help identify cancers at the earliest stages, when treatment can provide the best prognosis.

Anal cancer is not very common, so screening of the general public is not widely done. However, people who are considered to have a higher than average risk of developing anal cancer may be advised to undergo regular screening for the condition.

Screening tests for anal cancer may include:

• Digital rectal examinations
• Anal cytology testing, also known as an anal Pap test or smear

An anal Pap smear is very similar to a Pap smear for cervical cancer. The anal lining is swabbed to collect cells, which are then looked at under a microscope to see if any cells show pre-cancerous signs.

Those who might benefit from anal cancer screening include:

• People who are HIV positive
• Men who have sex with men
• Women who have had cervical cancer or vulvar cancer
• People who take immunosuppressants after receiving an organ transplant
• Occasionally, people with a history of anal warts are recommended to have screening

Anal cancer treatment

The treatment of anal cancer depends on the size of the cancer, the exact type of cancer and whether the cancer has spread. The treating doctor can give the best advice as to treatment.

Anal cancer can be treated by one or more of the following:

• Radiotherapy
• Surgery
• Chemotherapy

Often, the first step in treatment for anal cancer is a combination of radiotherapy and chemotherapy, known as combined modality therapy (CMT). Anal cancer may be curable in this way without the need for surgery.

Anal cancer chemotherapy

The general aims of chemotherapy treatment for anal cancer are to destroy any tumor tissue and increase the likelihood of recovery.

Chemotherapy can sometimes have unpleasant side effects, such as hair loss, nausea and vomiting, fatigue and pain. A doctor will be able to advise on how best to manage the side effects, should they occur.

Read more about Chemotherapy Side-Effects.

Anal cancer radiotherapy

Also known as radiation therapy, this uses X-rays to destroy cancer cells. Radiation for anal cancer can have unpleasant side-effects, such as diarrhea, skin irritation and nausea. A doctor will be able to advise on how best to manage the side-effects, should they occur.

Anal cancer surgery

Surgery is not normally the first treatment for anal cancer. If needed, the type of surgery will depend on the type and size of tumor. There are two main types of anal cancer surgery:

Local resection

This removes the tumor and a small area of normal tissue around it. A local resection is commonly used for tumors on the anal margin – the skin at the end of the canal that meets the anus opening – that are small and have not spread to other tissues or to lymph nodes.

Local resection normally allows the sphincters to be saved, so that a person may continue normal bowel movements after surgery.

Abdominoperineal resection for anal cancer

Abdominoperineal resection (APR) is an operation in which the anus and rectum are removed, possibly along with some nearby groin lymph nodes. APR requires a colostomy, in which the end of the colon is diverted out through the wall of the abdomen, leading to an external bag to collect stool and other human waste.

Good to know: APR is only used if other treatments don’t work or if the cancer returns after treatment. Nowadays, APR can almost always be avoided by using chemotherapy and radiotherapy instead.

APR surgery is more likely to cause long-term complications, such as urinary incontinence and sexual dysfunction. A doctor will be able to advise on how best to manage side-effects, should they occur.

Anal cancer prognosis

Anal cancer tends to spread slowly. With early treatment, in many cases it has a relatively good prognosis and may be curable.

In order to determine how the cancer should be treated, such as whether potentially life-changing surgery will be required, doctors will find out the size of the cancer and whether it has spread or metastasized to nearby lymph nodes or to distant organs, in a process known as staging.

Earlier stage cancers are more likely to be curable than more advanced stages, i.e. with larger tumors, and/or cancers that have spread.

Factors associated with poorer outcomes may include:

• Tumors in the anal canal rather than the anal margin
• Tumors greater than 5cm
• Tumors that invade nearby organs such as the urethra or bladder
• Lymph node involvement
• Being HIV positive

What are anal cancer survival rates?

Survival rates show what percentage of people live for a certain length of time after being diagnosed with cancer.

Survival rates are generally sorted into 5-year and 10-year time brackets. Because the statistic is based on people diagnosed over five years ago, the outlook may be better for those diagnosed today, since there are continuing improvements in treatment.

Survival rates include people who are free of disease or who experience few symptoms, as well as those who are still being treated for cancer, those who will survive for many more years and those who will not live much longer than the time bracket given.

Five-year survival rates for people with anal cancer in the U.S. are currently as follows:

• Localized anal cancer: About half of all anal cancers are found early, when they are localized, meaning they have not spread beyond the anus. The five-year survival rate is about 80 percent.
• Locally advanced anal cancer: If the cancer has spread to the lymph nodes or other areas around the anus, this is known as locally advanced cancer. The five-year survival rate is about 61 percent.
• Metastatic cancer: If the cancer has spread further to other parts of the body, it is known as metastatic cancer. The five-year survival rate is about 30 percent.

The overall five-year survival rate for anal cancer is about 66 percent.

Good to know: Survival rates do not predict what will happen to someone. Treatment and responses to treatment vary greatly.

Anal cancer FAQs

Q: Anus cancer vs hemorrhoids – how can I tell the difference?
A: Hemorrhoids, also known as piles, is a very common condition involving dilated rectal veins, that typically causes no serious health problems. It can often be treated at home, without being seen by a doctor.

Some symptoms of hemorrhoids, especially bleeding from the anus, may also be caused by anal cancer, a serious condition requiring prompt treatment. Other common symptoms between the two conditions include pain, pressure, itching, mucus discharge and a lump in or around the anus. Swelling of the lymph nodes around the anus or in the groin may be a sign of anal cancer. A hard growth tends to suggest anal cancer while a squishy swelling suggests hemorrhoids. For more information on what they look and feel like, see this resource on hemorrhoids.

A person should seek help for hemorrhoid symptoms if they have heavy rectal bleeding or bleeding that is not responding to home care, or hemorrhoid symptoms accompanied by fever, weight loss, abdominal pain, or a change in bowel habits.

Q: Is anal cancer curable?
A: Anal cancer tends to spread slowly. With early treatment, in many cases it has a relatively good prognosis and may be curable. Earlier stage cancers are more likely to be curable than larger tumors and cancers that have spread.

Factors associated with poorer outcomes may include:

• Tumors in the anal canal rather than the anal margin
• Tumors greater than 5cm
• Tumors that invade nearby organs such as the urethra or bladder
• Lymph Node involvement
• Being HIV positive

Q: Is anal cancer painful?
A: A person may experience pain due to anal cancer. The severity of the pain may depend on many factors, including the stage of the cancer, the treatment plan, and the affected person’s tolerance for pain. The cancer itself may cause pain, or pain may be a side effect of anal cancer treatments. Those with advanced anal cancer are most likely to have severe pain. Medical care for anal cancer will include pain-relief.

Q: Anal cancer vs colon cancer – what is the difference?
A: Colon cancer, also known as colorectal cancer, occurs in the colon or large intestine, the final six-foot section of the large intestine up to the anal canal. Anal cancer refers to several types of cancer that affect the anus, which is comprised of the anal canal, a passage about 3-4 cm or 1.5 inches connected to the colon and the anal margin, also known as perianal skin, the opening where feces is excreted from the body. Colon cancer is the second most common cancer in the U.S. and third most-common cause of death from cancer, whereas anal cancer is rare and has a fairly good prognosis because it is more likely to be caught early and tends to spread slowly.

Pilonidal Cyst/Hemorrhoids Specialist – Edison, NJ & Jersey City, NJ: Ravikumar Brahmbhatt, MD, FACS: General Surgery and Advanced Robotic Surgery

What is a pilonidal cyst?

A pilonidal cyst is pocket of skin that develops when hair punctures and gets embedded in the skin. They usually occur on the tailbone of your backside. It can look like a pit or pore in the skin with a darkened spot.

Pilonidal cysts are more common in men, but you’ll be at greater risk of developing a cyst if you sit for long periods of time.

Doctors theorize that the cyst develops when a loose hair gets caught on your skin and becomes embedded. Your body then treats the hair like a foreign object and forms a cyst.

What are the symptoms of a pilonidal cyst?

Your pilonidal cyst might not cause symptoms unless an abscess has formed, which is when the area around the cyst becomes inflamed and swollen.

Symptoms include:

• Pain
• Redness and swelling around the cyst
• Drainage at the cyst that could be foul-smelling

If you’ve discovered a pilonidal cyst, you should have it examined for treatment.

How are pilonidal cyst treated?

If your pilonidal cyst has turned into an abscess, surgery is your only option. Antibiotics aren’t an effective treatment for this type of an infection.

Initially, Dr. Brahmbhatt will treat your pilonidal cyst by draining it. During the procedure, he first numbs the area, then makes an incision and drains the puss. Dr. Brahmbhatt performs this procedure in the office.

After the procedure, Dr. Brahmbhatt will provide specific instructions on how to care for your incision to prevent infection. Unfortunately, drainage of your pilonidal cyst might not prevent a recurrence.

What can I expect during a pilonidal cystectomy?

If your pilonidal cyst recurs after drainage, Dr. Brahmbhatt will probably recommend a pilonidal cystectomy, which is the removal of your cyst.

Before he begins, Dr. Brahmbhatt administers anesthesia, then removes the cyst and the surrounding tissue and packs the wound with gauze. Sometimes a tube is placed at the site of the incision to help drain away fluid. The tube is later removed.

Dr. Brahmbhatt will provide instructions on how to care for your wound at home and when to come back to the office for follow-up.

For removal of your pilonidal cyst, call RR Surgical Associates or schedule an appointment online today.

What are hemorrhoids?

Hemorrhoids are swollen veins, similar to varicose veins, that develop in your anus or rectum. They’re very common, and while some people develop hemorrhoids for unknown reasons, they most often result from bowel-movement strain related to constipation. Pregnant women are also at risk of developing hemorrhoids due to the added pressure on the veins from the weight of the pregnancy.

What are common symptoms of hemorrhoids?

Hemorrhoids don’t always cause symptoms, so you might not even be aware that you have them. Common symptoms include:

• Appearance of bright red blood after a bowel movement
• Anal burning or itching
• Pain or discomfort
• Development of a painful lump near your anus

The severity of the symptoms vary, but some people find the discomfort difficult to live with.

After reviewing your symptoms, Dr. Brahmbhatt performs an examination that can include a digital exam or visual inspection, to determine if hemorrhoids are in fact responsible for your discomfort.

Do I need surgery for hemorrhoids?

Surgery isn’t always necessary for hemorrhoids. Dr. Brahmbhatt will review all of your treatment options to relieve your pain, which can include:

• Over-the-counter hemorrhoid medication
• Over-the-counter pain relievers
• Regular warm baths or sitz baths
• Changes in your diet to improve bowel function

If your hemorrhoids are bleeding regularly or causing pain, Dr. Brahmbhatt can surgically remove the swollen vein.

What is a hemorrhoidectomy?

A hemorrhoidectomy is the surgical removal of a hemorrhoid. During the procedure, Dr. Brahmbhatt removes the hemorrhoid and excessive tissue that could be contributing to your pain or bleeding. A hemorrhoidectomy is the most effective treatment for severe and recurring cases of hemorrhoids.

Could it be something else?

While hemorrhoids are the most common cause of rectal pain and discomfort, it could be something else, such as an anal fistula, anal fissure, or abscess of the perirectal or gluteal area. Dr. Brahmbhatt can determine the cause of your pain during your evaluation and, if necessary, can perform the appropriate procedure.

Dr. Brahmbhatt can also evaluate for causes of groin pain, other reasons you might be having blood in your stool, and causes of abnormal rectal discharge.

For expert surgical care from the team that provides community service with excellence, call RR Surgical Associates or book an appointment online today.

Pelvic Floor Dysfunction

Definition
Pelvic floor dysfunction is a condition characterized by weak muscles surrounding the bladder, uterus (women), prostate (men), and rectum. Individuals with this condition experience difficulty relaxing the muscles of the pelvic floor. As a result, they cannot produce complete bowel movements. There are many disorders that can cause the improper functioning of pelvic floor muscles. A physician may administer a thorough physical examination and health history evaluation to determine whether or not pelvic floor dysfunction is present. 

Causes
Pelvic floor dysfunction is often the result of an underlying condition or obstetrical (child-bearing) history in women. Conditions that may lead to pelvic floor dysfunction include rectocele, paradoxical puborectalis contraction, and pelvic pain syndromes (i.e. coccygodynia, proctalgia fugax, and pudendal neuralgia). Women who experience difficult childbirth may be at risk of developing pelvic floor dysfunction.

Risk Factors
Taking a patient’s medical history is immensely valuable when diagnosing pelvic floor dysfunction. Women with a history of difficult deliveries, which often includes forceps deliveries, prolonged labor, or episiotomies (incision made between the vaginal opening and anus to help with childbirth) are at risk of developing pelvic floor dysfunction. Additionally, patients with a history of bowel irregularities (i.e. diarrhea, constipation, etc.) and anorectal surgeries are at an increased risk of developing this condition. Patients should have their symptoms, current health status, and medical history evaluated if pelvic floor disorder is suspected.

Symptoms
Because pelvic floor dysfunction causes abnormalities with bowel movements, pain, and other symptoms may be present. Symptoms of pelvic floor dysfunction often include:

• Urgent, painful, or frequent urination
• Incomplete emptying of urine or bowels
• Straining or pain during bowel movements
• Pain in the lower back, groin or rectum
• Pain during or after sexual intercourse
• Muscle spasms in the pelvic region

Treatments
Pelvic floor dysfunction can be debilitating, which is why patients may want to consider treatment to experience relief from their symptoms. Treatment for pelvic floor dysfunction often includes a combination of techniques such as self-care, medication, physical therapy, or minimally invasive surgery. Unique treatment modalities like biofeedback, electrical stimulation, interferential therapy, ultrasound therapy, and cold laser therapy may also be considered to treat pelvic floor dysfunction. 

90,000 Won’t work on its own. It hurts in the left side – what it can be and how to help yourself

They often complain of pain in the left side. It can be caused simply by an unsuccessful movement or overexertion, which will pass over time. But pain in this place can signal serious causes and dangerous diseases, because this area contains many vital organs. And if the pain recurs, it is definitely not worth postponing the visit to the doctor.

Pain in the left side of the abdomen may be the first sign of a threat to a person’s life.Most organs have cavities, so inflammation or trauma can lead to internal swelling or bleeding and eventually death. Today in the project “It won’t work by itself” we will figure out what can be the cause of pain in the left side, and why these unpleasant sensations cannot be ignored. The project comes out in partnership with experts from the Republican Diagnostic Center (RDM).

Why does the left side hurt?

Answers can be ten. On the left we have many vital organs: the left kidney and adrenal gland, the spleen and part of the intestine, the pancreas and the left side of the stomach, the left side of the diaphragm, the bladder, the uterus and the ovaries in women.The reason may not be so obvious – failures in the work of the heart often make themselves felt by reflected pain in the left side of the body. One-sided pain on the left may indicate diseases of these particular organs.

True, unpleasant sensations do not always speak of diseases. Muscles can ache, the cause of discomfort can be increased gas production, constipation or excessive physical exertion.

To understand which doctor to contact with your problem, pay attention to the nature of pain .It can be sharp, sharp, dull, or aching.

Severe pain

Sharp pains in the lower left abdomen are caused by spasms, passage of uroliths along the urinary tract, rupture of the inguinal ligaments, inflammation, rupture of the ovary, expansion of the renal pelvis or bladder. The following diseases can cause such pain:

• Muscle pain. You could have just overdone it in training or sat in a draft.Or maybe you have poor posture, stress, or an autoimmune disease. Muscle pain has dozens of reasons. If the pain in the side appeared after exercise or, for example, after you sweated and sat under the air conditioner, you can simply endure it. Take an over-the-counter pain reliever to relieve the condition. But if the unpleasant sensations do not go away for 3-4 days, intensify, or if you have no idea about their causes, be sure to visit a therapist. The doctor will clarify the diagnosis and prescribe treatment.

• Heart problems. Pain – sharp or dull – in the left side can also cause various heart disorders, from angina pectoris to heart attack. If you are regularly worried about pain in the left hypochondrium, radiating to the shoulder or arm, in no case do not leave them unattended. Be sure to consult at least a therapist or immediately contact a cardiologist. Sharp pain in the left hypochondrium, accompanied by weakness, breathing problems, abdominal pain, arrhythmia is an unambiguous indication for an immediate ambulance call.We can talk about a heart attack, and here every second counts.

• Stones or other kidney disease. Urolithiasis, pyelonephritis, and other renal disorders manifest themselves as sudden excruciating pain in the lower abdomen. Such pain clearly radiates to the lower back and then intensifies, then weakens. If you suspect a kidney problem, do not hesitate to visit a nephrologist. The doctor will make an accurate diagnosis and prescribe the necessary medications.

• Colon pathology .In this department, neoplasms and other pathologies most often occur. Acute pain can cause Crohn’s disease – the formation of nodes in the colon and their inflammation. At the same time, there is weakness, impaired appetite, nausea and diarrhea. The reason may be intestinal obstruction – a violation of the movement of feces due to spasms, neoplasms and other obstructions in the intestine. Due to the accumulation of feces, the stomach begins to swell, severe pains and constipation appear. Another reason – colitis – inflammation of the mucous membrane.It causes discomfort of varying intensity, diarrhea mixed with blood and pus, a periodic rise in temperature. Hemorrhoids can also cause pain: with varicose veins of the rectum, pain occurs after a bowel movement and can last for several days. It is accompanied by other symptoms: bleeding, discomfort, a feeling of heaviness and frequent constipation.

Stitching, sharp pain

Such pain occurs when the integrity of the organs is violated.Stitching pain can be a harbinger of rupture of the ovary, a consequence of intestinal distention with gases, a companion of kidney disease or ulceration of the mucous membranes of the urethra or ureters. The following diseases can cause such pain:

• Pneumonia or pleurisy. These diseases are most often caused by bacteria or viruses. Recognizing lung lesions is easy: acute chest pain occurs with deep breathing or coughing. Additional symptoms: fever, weakness, chills, difficulty breathing.

• Ruptured spleen . The spleen is very close to the surface of the skin, so it can be easily injured. With strong blows, rupture of this organ is possible. After injury to the spleen, acute pain appears and a hematoma forms near the navel. If there is a suspicion of a rupture, you should go to the hospital very quickly.

• Stomach ulcer. An ulcer is a defect in the stomach lining. When craters appear, discomfort occurs immediately after the next meal.The disease is accompanied by frequent heartburn, vomiting, and weight loss. The most dangerous complication of ulcers is the formation of a hole in the wall of the stomach. At this moment, patients feel acute pain, their skin turns pale, sometimes patients lose consciousness. If such signs appear, immediate hospitalization is necessary.

• Ectopic pregnancy. An ectopic pregnancy is said to be when a fertilized egg is attached not to the uterus, but to the fallopian tube, cervix, ovary or other place in the abdominal cavity.Sooner or later, the growing embryo tears apart the organ to which it has attached. This can lead to severe and fatal bleeding and peritonitis. If you are pregnant or suspect it, then any acute pain in the lower abdomen, especially if it is accompanied by dizziness, nausea, bloody discharge and does not go away within a few minutes, is a definite reason to call an ambulance.

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Dull and aching pain

It occurs in inflammatory processes.Dull pain usually accompanies unilateral “female” diseases. If dull pain sensations are combined with fever, rapid fatigue, general weakness, then, most likely, we are talking about inflammatory pathologies. The following diseases can cause such pain:

• Strong physical activity. You ran fast or jumped too vigorously, and then your left side hurt. There is nothing to worry about: physical activity increases blood flow, if it is excessive, the blood fills the spleen.The organ increases in size and begins to press on its own shell-capsule, which contains nerve endings. This is how the famous “pricks in the left side” appears.

• Stomach pathologies . Discomfort in the stomach area can be associated with manifestations of gastritis, peptic ulcer disease or tumors. With gastritis, the mucous membranes become inflamed and cause aching discomfort in the abdomen on the left. The disease also manifests itself with other symptoms: belching with a very unpleasant odor, bouts of nausea, heartburn after eating, heaviness.Inflammatory processes on the mucous membrane sometimes provoke diarrhea or constipation.

• Bowel pathology. In the small intestine, food is broken down after being digested in the stomach. Some people have innate characteristics: their body does not accept gluten and milk sugar. After some foods, they develop flatulence, periodic pulling pain. Additional signs: weight loss, hypovitaminosis, an increase in abdominal circumference, frequent rumbling.

• Appendicitis. In most cases, inflammation of the appendix makes itself felt with pain in the right side. However, sometimes pain occurs in the upper left abdomen. If the causes of dull pain on the left are unknown to you, but at the same time you notice bloating, loss of appetite, fever – be sure to consult a therapist as soon as possible.

• A type of cancer. Unfortunately, cancer of the intestines, stomach, pancreas in the early stages almost do not make themselves felt. They can be noticed except for some discomfort in the abdomen, mild symptoms of indigestion, unexplained weight loss.

Pulling pain

Such pain appears during the formation of purulent foci. Pulling left-sided pain is usually characteristic of purulent pathologies of the pelvic organs, it occurs when the ligaments in the groin and strangulated hernias are stretched, and also accompanies cancer (in this case, its intensity increases over time). The following diseases can cause such pain:

• Spleen pathology . This organ takes part in the process of blood formation, it utilizes dead erythrocytes.When the spleen is unable to cope with its functions, mononucleosis develops. This pathology leads to an increase in the organ and a change in the morphological structure of its tissues. With mononucleosis, there is a constant pulling pain in the abdomen on the left. The disease is accompanied by other symptoms: fatigue, aching muscles or joints, frequent headaches, impaired thermoregulation. In addition, immunity decreases, the body becomes sensitive to all viral and infectious diseases.

• Pathology of the pancreas The pancreas is located closer to the left side of the abdomen and is one of the components of the endocrine system.It produces enzymes and hormones that promote the breakdown and absorption of foods and regulate the work of some organs. Pulling and thrilling sensations appear due to certain foods, usually fatty foods or smoked meats. Additional symptoms – high fever, profuse vomiting and stool disturbances – signal that it is worth contacting a gastroenterologist.

• Menses . During or before your period, your lower abdomen may hurt. Including in the left part of it, sometimes giving it to the back.Menstrual pain, while unpleasant, is not dangerous. You can simply endure it or take an over-the-counter pain reliever.

• Endometriosis or ovarian cyst. These diseases can be recognized by pulling pains in the pelvic region – both to the left and to the right. The sensations are similar to menstrual cramps, but can appear at any time. With such violations, menstruation lengthens and becomes more painful. It is important to make the correct diagnosis on time, sometimes life depends on it.For example, rupture of a large ovarian cyst can cause uterine bleeding and death from blood loss.

The presence of such pain should be the basis for seeking help from a doctor. At the same time, it is important to pay attention to the accompanying symptoms – elevated body temperature, diarrhea, vomiting, pallor, lethargy, etc. You must definitely inform a specialist about them, this information will be useful for making an accurate diagnosis.

When there is no time to figure it out, but you need to call an ambulance

If you feel these symptoms, call an ambulance immediately.Don’t try to wait for the pain to go away.

• Acute or dull pain on the left side of the chest radiates to the left arm, shoulder, jaw.
• Perceptible pain is accompanied by an increase in temperature to 38.8 ° C and above.
• Sudden sharp pain is concentrated in one point and does not stop for several minutes.
• Severe abdominal pain (both on the left and at any other point), and relief comes when you lie still on your back.
• The pain does not subside over time, but intensifies.
• Pain accompanied by vomiting. The situation is especially threatening if there is blood in the contents of the stomach.
• The pain is sharp, it is impossible to urinate.
• Black or blood-streaked stools.
• The abdomen is tense, even the slightest touch is painful.
• In the lower abdomen – severe pulling or stitching pain, and at the same time you are pregnant or do not exclude it.
• Shortly before the onset of severe pain, there was a blow to the stomach or ribs.

Be alert to any incomprehensible sensation in the left side.If they become regular, be sure to consult with a therapist or gastroenterologist and go through all the examinations prescribed by them. Remember, timely examination can prevent many diseases.

Be healthy!

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90,000 neurologist, chiropractor Bashirova Elena Shamilevna.

The first commandment of a doctor in oriental medicine is the rule: do not heal a disease,
treat the patient.Nowadays, these words can be applied to almost any
narrow medical specialty. Unfortunately, in our time, sometimes doctors do not treat
a person, and a disease, and sometimes even already an organ. The patient does not seem to be a single organism, but a bunch of separate organs, which, like in a store, are given to a specialist
for treatment. Then as soon as complex
an approach to the treatment of the whole organism can give a good result. Today everything
more and more doctors are coming to understand the need for a comprehensive
approach to dealing with the disease.Manual
therapy is one of those methods
treatments that take into account the condition of the whole organism as a whole. Who
is such a chiropractor? V
In Russia, manual therapy “grew” out of neurology. Manual
a therapist is necessarily a doctor
with the basic specialization “traumatologist-orthopedist”. Only these specialists have the right to pass
manual therapy courses and
receive a certificate upon completion. Every chiropractor
must be extremely careful
performing manipulations.The principle of “do no harm” must be strictly observed.
Even Hippocrates asserted that: “THE CAUSE OF ALL DISEASES LOCATES IN THE SPINE”
The spine is the core of health,
the basis of our entire body.
Any ailment in all parts of the body is always reflected in the spine and vice versa – diseases of the spine immediately “pull” a lot of different disorders
and diseases, starting with the usual functional block of one of the vertebrates
segments, different variations of the lesion
intervertebral disc (including hernia
disc) and ending with diseases affecting the entire spinal column (in the first
turn, this is osteochondrosis).The fact is that a vertebra displaced from its physiologically determined place can cause
intervertebral infringement
disc, spinal roots, nerves, which in their
queue cause tension
muscles and ligaments, block them
mobility, lead to venous stasis in a certain area.
All this causes pathological
changes in all organs reflexively associated with this vertebral segment. On the other hand, pathological changes can begin
in the intervertebral disc (or meniscus
joint).Its deformation also causes infringement of the spinal roots.
and all other pathological changes in
the body. Manipulation of manual therapy, moving away the surfaces of the joints
from each other and restoring blood circulation in this area, create
conditions for its regeneration. Besides,
there is a theory of venous stasis, when a slowdown in the removal of metabolic products from
vertebral bodies and intervertebral discs
accompanied by pain and
changes in it.Pathological impulse from a sick person
organ, entering the segment of the spinal cord, “responsible” for this organ, causes a local change in muscle tone
and circulatory disorders. Wherein
there is a blockade of the motor segment
the spine at the level of the lesion that
in turn, it provokes the sending of pathological impulses back to the diseased organ. This leads to a closure
vicious circle, which means the progression of the disease and its transition into a chronic
shape.The doctor, by “breaking” the vicious circle, helps to cure most chronic diseases or to alleviate them
leakage. Due to the widespread use of soft techniques, the volume of contraindications to manual therapy has noticeably decreased. Therefore, this issue is being resolved
doctor – chiropractor at a consultative appointment.
A connection has been established between diseases of the spine and the work of the reproductive system. Osteochondrosis of the chest or
lumbosacral spine (including, in the absence of pain
syndrome and, accordingly, the patient’s complaints) can cause pinching
the roots of nerve fibers along which
the innervation of the organs of the reproductive system is carried out.First of all
in violation of the correct position
the spinal column and pelvic bones suffer from the nerve nodes of the autonomic nervous system, lying on the surface of the vertebrae
and sacrum. It is from these nodes that
innervation of internal organs, therefore
even small violations of the position of the vertebrae lead to the appearance of a wide variety of diseases. It is no coincidence that many diseases begin with hypothermia.
or nervous strain, which,
causing muscle tension, cause
displacement in the osteoarticular sphere, then
violation of innervation and, as a result,
disease.In addition, from these nodes, most of the nerve fibers are directed
to the vessels through which blood flows to
organs and tissues. As a rule, organ diseases are accompanied by a violation
primarily venous outflow, which is manifested by visible changes
venous pattern on the skin of the abdomen and lower back.
Of great importance for the development of diseases of organs located in a small
the pelvis has the position of the sacrum and pelvic
bones. The sacrum “closes” the small
the pelvis, and with prolonged restriction of the movement of the sacrum, the pressure in the area
small pelvis, and this subsequently leads to
the development of congestive prostatitis or
anedomas of the prostate gland in men, uterine fibroids in women and hemorrhoids with
enterocolitis – in all.Bone disorders lead to changes in this area.
balance – violation of position
pelvic bones relative to each other
friend, decreased mobility between
pelvic bones. There are three points that
must be in free movement: the pubic articulation and the two sacroiliac joints. If in this system
there are violations, the balance is disturbed
muscles and ligaments, and as a result – gynecological problems: menstrual irregularities, painful menstruation
other.Groin pain, pain in
the lower abdomen during menstruation can be caused not at all by a disease of the pelvic organs, but by reflected pain, the source of which is
at the level of the lumbosacral region
spine.
Sacrum and pelvic bones in a certain
least affect the work of the ovaries. The mechanism of this influence is quite simple:
the ligaments that support the ovaries are connected to the sacrum, therefore, if the position and movement of the sacrum is impaired, then
and the ovaries are not working properly.So
way, bringing the position of the pelvic and sacral bones back to normal, manual treatment
normalizes the menstrual cycle when
using the body’s own resources, without the use of hormonal
drugs. Treatment of painful menstruation is carried out approximately at the same
the same scheme.
Pregnancy, childbirth, breastfeeding, baby care
Are periods of maximum
load on the whole body
women and in particular on
spine. If you are after
childbirth experience any first-time
back pain, small pelvis,
joints of hands and feet or
headache, dizziness, then one of
specialists who
can help in this situation, is a manual
therapist.Often, women turn to such doctors only in cases of pronounced, long-term pain.
Take good care of your health,
try to make time and visit a chiropractor with a preventive
purpose. It is worth contacting a doctor even before pregnancy; check and, for
necessary, to correct the position and
movement of the pelvic bones and lumbar spine, thereby preventing
complications as during pregnancy,
and in subsequent childbirth.In childbirth, very
the condition of the pelvic floor is important. Violations
in the musculoskeletal system of the pelvis, putting pressure on the nerve nodes located on the walls of the pelvis cause pain not only in the lower back, but also in the lower abdomen
and in the groin. Often these pains appear after
severe pregnancy and difficult childbirth.
It so happens that abdominal pain predominates, but lower back pain is not expressed or absent. This distribution of pain is often
causes serious diagnostic difficulties for doctors, therefore, manual
the therapist, such patients come after
unsuccessful treatment by a gastroenterologist
or a gynecologist.What it takes to be on time
to find the true source of pain? To do this, you need to listen to yourself. Koreshkovaya
abdominal pain can be easily triggered by movement – bending forward or
sideways. This pain does not go away after taking
antispasmodic drugs – no-shpy
or papaverine, but it decreases significantly after taking anti-inflammatory drugs. Long stay
standing or sitting with the baby on
hands, local warmth on the stomach, or lying
in a hot bath can exacerbate this pain,
at the same time, prolonged rest in the supine position with the lower back placed underneath
roller can eliminate it overnight.Have
chiropractor has its own diagnostic criteria, focusing on which
it defines the responsibility of the spinal column in the production of pain. Restoring normal joint mobility
spine relaxing tense
muscles, doctor (the one who heals with his hands)
eliminate this painful impulse,
disguised as some kind of chronic adnexitis or inflammation of the blind
intestines.
Unfortunately, in more than 10% of cases
gynecologists and endocrinologists are not
can establish the cause of infertility.Before
recently it was considered unlikely, but today it is a fact that manual
therapy in some cases is able to cure infertility, the cause of which could not be identified before.
Recent Application of Manual Therapy in Urology-Andrology and Gynecology
led to the fact that the effectiveness of treatment
increased significantly compared to
those patients to whom the method of manual therapy was not applied.
Treatment by a chiropractor of urological and gynecological diseases
the sphere must be controlled and
with the interaction of specialists – urologist and gynecologist.Joint integrated
the treatment will give the best results!

Indications for referring the patient to
chiropractor from a gynecologist:

• Pain (pain syndromes) in the lower back,
  pelvis, groin, abdomen, perineum, buttocks.
• Disorders of blood supply in the area
  pelvis and lower extremities: dysfunctional uterine bleeding, congestion in the small pelvis, varicose veins
  uterus or vagina, adenomyosis, endometriosis, uterine fibroids.
• Preparing for pregnancy, miscarriage
  or a missed pregnancy in
  anamnesis.
• Prolapse of the pelvic organs.
• Menstrual irregularities.
  from a chiropractor from a chiropractor.

Itching in the anus: causes, treatment

If, despite regular hygiene procedures, the anal itching does not go away within 1-2 days, see your doctor. You will need a consultation from a proctologist or coloproctologist, men should consult a urologist, women should consult a gynecologist. If discomfort is accompanied by diarrhea or constipation, you will need the help of a gastroenterologist.

Causes of itching in the anus

Why do these unpleasant and sometimes painful sensations arise at all? The causes of itching in the anus in adults can be unexpected. Among them:

Diseases of the rectum

1. The appearance of warts and genital warts. These diseases are not accompanied by any other symptoms, except for excruciating itching, and a small seal can be felt directly at the anus.
2. Anal fissures, anorectal fistulas, rectal polyps. These diseases are accompanied not only by itching, but also by pain, from time to time blood appears in the feces and in the discharge from the rectum.
3. Hemorrhoids. In this case, itching is accompanied by pain, bloody discharge, burning sensation, and a feeling of heaviness in the anus. Hemorrhoids can be internal or external, but internal nodules are more likely to cause itching. They ulcerate, burst, feces and mucus get into the cracks.This causes discomfort.
4. Condylomas – formations on the rectum caused by the action of the papillomavirus. They cause itching and foreign body sensation.
5. Proctosigmoiditis. This is an inflammation of the sigmoid and rectum with damage to the intestinal mucosa and impairment of its functions. This formidable disease leads to a narrowing of the intestinal lumen, perforation of ulcers and the involvement of nearby tissues in the pathological process. Early diagnosis and timely treatment are important here.
6. Malignant intestinal tumors. In the early stages, oncological diseases manifest themselves in the same way as other intestinal diseases – itching, dyspepsia or unstable stools, bloating, soreness in the lower abdomen. With early diagnosis, the chances of successful treatment of the disease increase.

Important! A person may not be aware of the presence of the underlying disease, since, apart from anal itching, he does not feel any other clinical manifestations. Therefore, it is important that a doctor determines the cause of your concern.

Helminthic invasions

An itching sensation in the anus can occur when infected with parasites that live in the intestines. The most common ones are:

• pinworms;

90,031 roundworms;

• giardia.

In the case of pinworms, itching occurs at night when parasites lay eggs in the anus to reproduce. Then redness or inflammation appears at the anus, sometimes digestion is disturbed.The rectum and large intestine suffer from the activity of parasites.

When infected with ascaris, itching occurs in the daytime. Sometimes a person, after having a bowel movement, may feel movement in the anus.

With giardiasis, a person suffers from diarrhea and abdominal pain. Frequent stools cause itching in the anus, a rash appears on the body – including in the perineum, and this increases the itching.

To get rid of this scourge, you need to be tested for the presence of parasites and undergo simple treatment.You will not only cleanse the body of uninvited guests, but also remove their waste products, get rid of chronic fatigue and weakness.

Important! Medicines for the treatment of helminthic invasion, the dose and duration of the course should be prescribed by the doctor. The patient cannot independently assess the nature of the lesion.

Diseases of the genitourinary system

In men, itching in the anus can be associated with diseases of prostatitis and urethritis.In this case, the urologist will prescribe the treatment.

In women, anal itching is accompanied by infections of the genitourinary system – gonorrhea, trichomoniasis, chlamydia. In this case, severe itching in the anus provokes vaginal discharge, which inevitably reaches the anus.

Gynecological infections can be successfully treated. But they can be chronic and run latently, therefore, not only how quickly you get rid of unpleasant sensations in the anus depends on timely diagnosis, but also how effectively you will preserve your women’s health.

Pubic lice sometimes cause itching in the anus. The doctor will detect them by visual examination and give recommendations for treatment.

A person may feel itching after anal sex, as the rectum inevitably receives microtrauma or irritation of the mucous membrane.

Candidiasis

If a colony of a fungus of the genus Candida is actively multiplying in the anal area, anal candidiasis should be treated.The disease occurs as a consequence:

• decreased immunity;

90,031 intestinal microflora disorders;

90,031 manifestations of allergies;

90,031 antibiotic intake;

90,031 occurrence of diaper rash.

With candidiasis, a person experiences soreness during bowel movements, itchy sores and swelling form around the anus.

The doctor will establish a diagnosis based on the scraping data, sometimes it may be necessary to examine the inner surface of the intestine with an endoscope.

Intestinal dysbiosis

There are many reasons for the appearance of dysbiosis – stress, decreased immunity, unhealthy diet or taking antibiotics. Dysbacteriosis is the cause of unstable stool, the absence of normal microflora leads to irritation of the intestinal mucosa and a person feels not only itching near the anus, but pain and burning.

Itching in infants

Inflammation, redness, diaper rash and itching are more likely to occur in young children if parents neglect hygiene and rarely change diapers.Also, in children, the cause of redness and itching around the anus can be a fungal infection of the skin – candidiasis.

Children can develop hemorrhoids if constipation occurs frequently and the gastrointestinal tract is disrupted. Therefore, observe the feeding regimen of babies, avoid foods that provoke constipation and uncontrolled consumption of sweets.

Dermatological problems

With psoriasis, dermatitis, seborrheic eczema, scabies, lichen planus, a rash and skin irritation occurs.If the pathology captures the buttocks and anus, painful sensations cannot be avoided. Sometimes the itching is so excruciating that a person cannot find a place for himself. Itching usually worsens in the evening.

Discomfort in the anus can be triggered by taking antibiotics.

Most people’s skin is sensitive to such external stimuli:

• Insufficient compliance with the rules of personal hygiene or the use of too aggressive, allergic detergents, irregular change of underwear;
• using substandard toilet paper,
• Wearing synthetic underwear, or poorly sewn underwear with rough seams that rub the skin.Especially if you are wearing too tight clothes on top. If itching occurs when moving, then it is enough to replace uncomfortable clothes;
• frequent use of thongs. A narrow strip of panties serves as a conduit for infection. Even in the case of ideal hygiene and high-quality materials, the groin begins to itch from the tension of the thong fabric, and microcracks appear during scratching, into which pathogenic microbes can enter.

It is not difficult to follow the rules of personal hygiene: water procedures should be carried out twice a day, change underwear at least once a day.It is better if the panties are made of natural fabric and do not fit too tightly to the body.

Already at the examination stage, the doctor will prescribe topical preparations that will ease the manifestations of the disease and relieve itching.

Diabetes mellitus

Constant itching in the anus and genitals is one of the hallmarks of diabetes. This is a consequence of an imbalance in the hormonal system – increased blood sugar leads to the release of glucose molecules through the skin.And they, in turn, serve as a breeding ground for microbes. At the same time, there is no exhausting discomfort, itching occurs from time to time. If the person with diabetes is overweight, the problem is exacerbated.

Overweight and unhealthy nutrition

Overweight people often experience skin irritation and diaper rash. A large area of ​​the skin forms skin folds and ridges that rub against each other and cause irritation. Such areas of the skin are sensitive to the penetration of pathogenic microbes.Irritation and increased sweating causes itching at the anus.

Improper nutrition can make life difficult for thin people. Unpleasant sensations in the anus can be caused by spicy foods and dishes abundantly flavored with spices. As well as citrus fruits, coffee, some beers and colas.

Diseases of the liver and pancreas

In case of malfunction of the liver, pancreas, poor patency of the bile ducts, bile acids and toxins appear in the blood.They irritate the receptors of the rectal mucosa and cause itching.

Stool disorders and frequent diarrhea associated with these diseases irritate the intestinal mucosa and increase the discomfort.

Neurosis, stress and neurogenic causes

In pathologically clean people, itching of the anus occurs more often than in those who relate to their own hygiene without fanaticism. Too clean and fat-free skin is especially susceptible to the effects of pathogenic microbes.

Restlessness, obsessions, life “on the nerves” can cause excruciating itching in the anus.

Itching can be painful at night and prevent anxiety-prone people who are depressed or stressed from falling asleep.

This symptom haunts those who suffer from alcoholism and drug addiction. Often, such patients do not associate the presence of addiction and an unpleasant clinical symptom, and yet anal itching is a sign of the strongest intoxication of the body.

How to relieve symptoms

It is possible to temporarily alleviate the manifestations of anal itching; for this, antimicrobial and wound-healing ointments are used. However, this is just a symptomatic treatment, and you need to find out and eliminate the cause of the disease.

Ointments should be applied after hygiene procedures. Sit in a sitz bath with herbal decoction, or douche with decoction of oak bark, sage, calendula.

Remember to follow a diet, both during treatment and for 2-3 weeks after its completion. You will have to give up alcohol, spicy and too salty foods and products containing caffeine.

If you suffer from anal itching – limit physical activity, weight lifting and exercise. Do not take a hot shower or go to the bathhouse or sauna.

Diagnosis of itching of the anus

When contacting a proctologist, the patient will be assigned a detailed study.It will include:

• consultation of narrow specialists: urologist, gynecologist, gastroenterologist, dermatologist;
• inspection of the skin and anus;
• conducting a blood test with mandatory monitoring of glucose levels;
• general urinalysis;
• biochemical blood test;
• analysis of feces for the detection of worm eggs;
• analysis of feces for enterobiasis;
• colonoscopy or anoscopy – if necessary, as decided by the doctor.

Treatment of itching in the anus

After the cause of anal itching has been determined, the patient is treated by a specialized doctor. Unpleasant sensations can be temporarily stopped with the help of medicinal ointments and suppositories, but the main goal is to cure the disease that caused itching.

Complex drug treatment is combined with a course of physiotherapy procedures.

If the cause of anal itching is nerve disorders, the patient may be recommended a course of sedatives and antihistamines.

If during the examination no diseases are found, the doctor can assume the presence of an inflammatory process in the rectum and prescribe a therapeutic diet, microclysters and rectal suppositories.

Inguinal hernia: symptoms, diagnosis, treatment of an inguinal hernia

If a rounded tubercle is found in the groin area, it is necessary to seek medical help as soon as possible.This symptom most often indicates the appearance of an inguinal hernia formation, which can lead to the development of serious complications, including life-threatening infringement of the hernia. In the clinic of the Central Clinical Hospital of the Russian Academy of Sciences, not only consultations are carried out on suspicion of this pathology, but also operations on compulsory medical insurance are performed.

What is an inguinal hernia?

The inguinal canal is the gap between the abdominal muscles. Nerve fibers are located there, as well as the rounded ligament of the uterus in women and the spermatic cord in men.A hernia is a prolapse of the peritoneal organs into the inguinal canal. With this disorder, a bulge forms under the skin.

An inguinal hernia is more common in men (the risk is 27%), but sometimes it occurs in women (the risk is 3%). Unfortunately, when a hernial protrusion is detected, patients do not immediately seek help. There is no conservative treatment for this pathology. The patient needs to receive high-quality surgical treatment in order to prevent hernia infringement or the development of other complications.

Inguinal hernia symptoms:

• dull, aching constant pain;
• Formation of a tubercle (diameter may vary) under the skin.

Soreness often goes away after rest. The bulge can vary in size depending on the degree of fatigue, exercise, constipation, and other factors.

Complications of hernia in the inguinal canal

For some time, a hernia may not cause any particular inconvenience to a person, but complications develop over time:

inflammation;
• tissue atrophy;
• violation of potency in men;

90,031 infertility;

• blood clots;
• intestinal obstruction;
• internal bleeding;
• damage to the hip joint.

The most dangerous complications that require emergency medical intervention are hernia infringement and intestinal perforation.

Benefits of treatment at the Central Clinical Hospital of the Russian Academy of Sciences

• Expert class operating equipment for minimally invasive surgery
• Opportunity to undergo rehabilitation in a specialized department

Inguinal hernia diagnostics

If a tubercle is found under the skin, you cannot try to set it yourself, squeeze and touch it.Such actions can cause complications, including damage to the peritoneal organs.

If a bulge appears, you need to make an appointment with a doctor. The specialist will diagnose and, upon confirmation of the diagnosis, will write out a referral for a planned operation.

Usually, palpation and examination are sufficient to make a diagnosis, but in some cases hardware diagnostics may be required: ultrasound, MRI or CT.

If a person with a bulging in the groin area suddenly has severe pain, fever, signs of intoxication appear, an ambulance should be called urgently.These symptoms indicate a strangulated inguinal hernia.

Routine hernia surgery

Typically, hernia repair is done routinely. A week before surgery, your doctor may prescribe:

• cancellation of anticoagulant intake;

90,031 special diets;

• complex of therapeutic exercises;
• taking antihistamines.

This operation is not classified as dangerous or complex.The risk of complications is minimal.

Hernia repair can be open or laparoscopic. With an open approach, the doctor makes an incision, performs an excision of the hernial formation and examines the tissues. In the absence of signs of necrosis, the contents of the hernia are reduced. Then suturing is done using the patient’s tissue or a special mesh. This eliminates the risk of recurrent hernia formation. In the laparoscopic approach, the operation is performed through small punctures. The surgeon monitors his actions through the endoscope camera.

The optimal surgical approach is selected taking into account the history, the patient’s condition, and a number of other factors.

Get expert advice or make an appointment

Surgical treatment of inguinal hernia at the Central Clinical Hospital of the Russian Academy of Sciences

At the Central Clinical Hospital of the Russian Academy of Sciences, experienced doctors examine patients with suspected hernia. If necessary, high-quality modern equipment is used for diagnostics. When the diagnosis is confirmed, you can get a referral for hernia repair according to the compulsory medical insurance.

Surgical treatment of hernia is performed by experienced highly qualified doctors using modern surgical techniques and the use of drugs that are safe for health, including anesthesia.

All operating rooms in the clinic are equipped in accordance with modern quality and safety standards. After the operation, the patient can undergo rehabilitation in a specialized rehabilitation therapy unit. This allows you to quickly return to your usual way of life.

Advantages of contacting the Central Design Bureau of the Russian Academy of Sciences:

• consultations of highly qualified specialists;
• modern surgical treatment with minimal risk of complications;

90,031 the possibility of rehabilitation in a specialized department;

• carrying out an operation for an inguinal hernia according to the compulsory medical insurance.

In addition to high-quality medical care, the patient at the Central Clinical Hospital of the Russian Academy of Sciences receives the careful and attentive attitude of all staff.Physical and psychological comfort has a beneficial effect on recovery times.

To register for examination and treatment at the Central Clinical Hospital of the Russian Academy of Sciences and to clarify the cost of services, you can call +7 (499) 400 47 33 or use a special form on the website.

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