Coloproctology

Experts in Coloproctology in Alicante

Coloproctology is a subspecialty of general surgery and digestive system that deals with diagnosis and treatment, whether surgical or not, of all diseases that affect the anus and the rectum: hemorrhoids, fissure and anal fissure, rectal abates, condilomes, Straight prolapse, intestinal inflammatory disease, polyps and rectum cancer.

Together with these classic processes, functional alterations such as anal incontinence and constipation have appeared, as well as other disorders of the ancal function, defecation and chronic pelvic pain. These last pathologies have a growing social demand due to the improvement of diagnostic techniques, as well as therapeutic procedures.

Some pathologies that collaproctology deals with

Hemorrhoids

In the anal channel there are vasculic structures that plow it. Under normal conditions they suppose an accessory mechanism of continence by ensuring a more effective anal closure. Physiologically there are three, although there may be other minors.As are normal structures, in the absence of clinic, even observing that they are thickened, they do not require treatment.

Hemorrhoids consist of the distal sliding of these structures with defecation, being able to swell, prolapse, congest and bleed. The hemorrhoidal crisis is frequently triggered by constipation, but also diarrhea can aggravate or trigger a crisis, because although the defining effort decreases, the significant increase in frequency is conditioning.

Hemorrhoidal pathology can be considered the most frequent disease of the anal region presenting high prevalence, affecting any age and without differences between men and women.

The most frequent symptom is the rectorrhagia, usually of living red blood that stains the toilet paper or water the deposition, and only occasionally cause anemia.

The prolapse is the second symptom in frequency order, appears with evacuation and can be aggravated until permanent and irreducible. Other symptoms are pruritus, disagree and dirty or mucous escape, the latter generally associated with greater prolapse. Pain is associated with a complication or associated pathology.

Pathological hemorrhoids are divided into internal ones, if they are above the toothed line, and external those that are below it. Internal hemorrhoids are classified into four degrees:

• Grade I: The hemorrhoid is located in the submucose tissue on the toothed line. You can defecate living red blood. It is the most frequent.
• Grade II: They stand out when defecating, but they are reintroduced spontaneously with the cessation of the effort.
• Grade III: They leave when defecating and the patient reintroduces them manually.
• Grade IV: Hemorrhoids are irreducible and always prolapsed.

Hemorrhoids may present sharpening episodes (acute hemorrhoidal crisis) consisting of symptomatic exacerbation due to mechanical irritation due to hard or chemical stool (caffeine, tea, spices, alcohol or acid liquid feces). External hemorrhoidal thrombosis, with intravascular clots at the external hemorrhoidal plexus level, usually produces pain with a high peak the first days and gradually yielding. The exploration highlights a induced violet or blackish area, well delimited in the anal margin and very sensitive to touch.

The treatment of hemorrhoids, regardless of their degree, must be individualized. Before little prominent hemorrhoids (grade I-II), the first therapeutic option is dietary hygienic measures and medical treatment:

• Avoid constipation with a high diet in waste and rich in fruit and vegetables.
• It is very important to drink 1.5-2 liters of water a day.
• Do not take food with spices and spicy, as well as avoid alcohol and coffee.
• Avoid using hygienic paper for cleaning after defecation and making seat baths with warm water.
• Medical treatment with flavonoids. They act by inhibiting certain mechanisms of inflammatory response, increase venous tone and reduce edema (500 mg, Venorutón).
• If the patient associates constipation, you can add punctually laxatives of volume to the diet: lactulose (Duphalac®), Plantago ovata (Plantabén®).

Creams, ointments and suppositories decrease the clinic in acute cases, reducing edema and inflammation. They do not serve to treat bleeding or prolapse and should only be used for a few days, mainly to treat the pruritus. Its continued use can cause sensitization dermatitis to local anesthetics, as well as cutaneous atrophy and rebel pruritus by corticosteroids that they usually carry in their composition.

The Fiber Association, Seat Baths and Venotonic and Antiedematous Medication, provides symptomatic improvement in 80-90% of patients with symptomatic internal hemorrhoids.

Medical treatment is not effective for hemorrhoids with an important degree of prolapse (degrees III and IV). For these patients, there is a wide range of surgical treatment possibilities:

• Sclerosing injections.
• Ligatures with elastic band.
• Photocoagulation
• Hemorridectomy.

Anal fissure

The anal fissure is an ulcer or loss of substance in the squamous epithelium of the anus, usually on the posterior middle line, which is characterized by intense pain during and after defecation. It can be accompanied by bleeding and difficulty for deposition. It is one of the most common anus-recal problems attended in consultation.

The majority are of an unknown cause, although the appearance of the symptoms is well related to an expulsion episode difficult with hard stools or with a diarrheal outbreak. These fissures, called idiopathic, are characterized by an increase in the closing tone of the anal channel as a result of an exaggerated activity of the contraction of the internal anal sphincter.

The soft separation of the buttocks and the traction of the anal margin, allow to visualize the fissure. The rectal touch is not always possible due to intense pain and should not be insisted on its realization. The exploration will also allow the hypertonia of the internal sphincter that is usually present.

Most fissures cure conservative treatment:

• Soften stool with fiber intake and abundant fluids.
• Seat baths with warm water 2-3 times a day and after defecation.
• Analgesics
• Botulinum toxin injection
• Use of ointments with different mechanisms of action:
  • Calcium channel blockers: Diltiazem.
  • Nitrates: Rectgesic®.

When these measures fail and the patient continues with symptoms and the fissure is evident to the exploration, the surgical treatment must be raised, the technique of choice being the internal lateral sphincterotomy, since it has demonstrated some cure rates of more than 90% in the long term .

Anal abuses and fistulas

Abscesses and anal fistulas are, in most cases, successive stages of a suppurative disease. The abscess is the acute phase and the fistula the chronic phase.

Perianal abscesses are presented as a painful and occasionally fluctuating tumor. Although, according to its location, they may not present external signs and take with anal pain, signs of sepsis such as fever or even urinary clinic. Before a patient with intense procalgia and fever, if it does not allow a rectal touch for pain, the proctologist is obliged to perform an anal exploration under anesthesia to rule out endoanal abscesses.

The treatment of anal abscesses is always surgical drainage. The location of the incision for approach will depend on the type of abscess and the extension that the infection presents at that time.

If after the resolution of the acute picture, the patient has chronic or intermittent pus stains, it is then an anal fistula. An exhaustive anal exploration must be performed to locate the fistulous holes and complete the study with complementary tests such as endoanal ultrasound or magnetic resonance in order to properly program surgery.

Surgical intervention is the treatment of choice before an anal fistula. There are multiple techniques (fistulotomy, sedal placement, progress flaps ...) that have proven to correct and treat the fistula and whose choice should be individualized for each patient.

Pilonidal sinus

The sinus or pylonidal cyst is a cavity that forms around a hair follicle in the intergute fold that generates a local infection at that level.

It is a relatively common process, not serious but very annoying that more frequently affects adolescents and young men. It predominates in people with abundant hair and brown skin.

They usually study asymptomatic until they infect and develop abscesses that fistulize through the midline or in their neighborhood.

The treatment of choice is surgery when the patient has acute an infection in the sacred-coximea region that heals with pain, blush and heat in the area associated at times for suppuration and fever. In these cases, the Sinus has abscess, so that a surgical drainage and leave it open to be able to perform daily priests and close by second intention.

If after the acute episode, the patient continues with discomfort or chronic suppuration in the same area, it is indicated to perform programmed Sinus surgery. The surgical alternatives in this case are multiple, so that the different options should be agreed and explained to the patient and perform the most appropriate for each case.

From the HLA HLAHERMOSA CLINIC UNIT, we offer specialized treatment to all the diseases and pathologies of the anus-Rectal region. Our objective, in addition to providing specialized and high quality care, is to correctly diagnose the proctological pathology with the most novel complementary tests to be able to offer the best and most innovative surgical technique. These conditions diminish in a very important way the quality of life of the people who suffer from them, which forces to go to the consultation of a specialist. Our more than twenty years of experience guarantee highly specialized service and attention.