Anorectal Disorders

Anorectal disorders affect the area where the anus and rectum meet. These organs play important roles in helping you have a bowel movement:

• The rectum is a pouch at the end of your colon (large intestine) that stores stool until you can eliminate it through a bowel movement.
• The anus is the external opening through which stool leaves the body. Rings of muscle within the anus (anal sphincter) form a tight seal to help you control bowel movements.

There are many types of anorectal disorders, including:

• Hemorrhoids: Hemorrhoids are blood vessels in the lining of the anus that help deliver blood back to the heart. Everyone has hemorrhoids. They only become bothersome when they swell, causing them to bulge out of the anus, or start bleeding.
• Fissures: Fissures are small tears in the lining of your anus.
• Abscesses: An abscess is a pocket of infected tissue (pus) around the anus.
• Fistula: If you have had an abscess for a long time, it can cause a connection to the bladder or vagina, called a fistula. Fistulas often require surgery to remove the abnormal connection between organs and the diseased portions of the colon.

Hemorrhoids happen when groups of blood vessels in the anus or lower rectum become swollen (inflamed). There are many reasons people get hemorrhoids, including repeated straining during bowel movements, pregnancy and the effects of aging. 

There are two types of hemorrhoids:

• Internal hemorrhoids happen deep inside the rectum. This area is less sensitive to pain, so you may not feel any discomfort. The only symptom you may notice is bleeding or swelling, especially after a bowel movement.
• External hemorrhoids occur near the lining of the anus and tend to be more painful. During a bowel movement, they may bulge out (prolapse) from the anus.  

Symptoms of hemorrhoids may include swelling or bleeding. Some hemorrhoids bleed after bowel movements. If the hemorrhoid is swollen enough to push out through the opening of the anus you may be able to feel a bulge of swollen tissue with your fingers.

Hemorrhoid treatments

The type of treatment that is best for you depends on whether the hemorrhoid is internal or external. Many people feel better with non-surgical treatments, such as taking a warm shallow bath and changing their bowel habits. Lifestyle changes, such as becoming physically active and eating a diet rich in high-fiber foods can reduce your risk of hemorrhoids.

If non-surgical treatments are unsuccessful, we may be able to treat the hemorrhoid during an office visit. In-office procedures are often quick and painless, but you may need to have more than one procedure to achieve lasting relief. If the hemorrhoid comes back after multiple treatments or becomes infected, you may need a surgical procedure. Learn more about our treatments.

In-office procedures for internal hemorrhoids

• Banding (rubber band ligation): We place special rubber bands around the base of the hemorrhoid. The bands decrease blood supply to the hemorrhoid, which makes it shrink and fall off within 7 to 14 days. 
• Sclerotherapy: Sclerotherapy uses a special chemical we inject into the hemorrhoid to shrink the blood vessels that feed it.
• Excision of thrombosed hemorrhoids: If a hemorrhoid develops a blood clot (becomes thrombosed), we remove it during a procedure known as an excision.

Surgical procedures for internal hemorrhoids

• Hemorrhoid energy therapy: This treatment uses heat to decrease blood flow into the hemorrhoid. Hemorrhoid energy therapy often brings relief in just one treatment.
• Transanal hemorrhoidectomy dearterialization: This quick, painless procedure uses a special tool to locate and cut off a hemorrhoid's blood supply. Our surgeons use special techniques to push prolapsing hemorrhoids higher up within the anus, which relieves discomfort until the hemorrhoid falls off.
• Hemorrhoidectomy: During a hemorrhoidectomy, we surgically remove the hemorrhoid. A hemorrhoidectomy can bring permanent relief after just one procedure. The procedure also has the highest risk of complications, which is why it is important to receive care from our experienced colorectal surgeons

A fissure happens when there is a small tear or open sore (ulcer) in the lining of the anus. Fissures can be confused with other conditions, such as hemorrhoids, which is why it is important to see an expert who specializes in diagnosing and treating anorectal disorders. Often a visual examination by a physician is all that is needed to diagnose a fissure.

Fissure symptoms such as pain and bleeding typically start during bowel movements. These symptoms can be severe and last for several hours. Fissures can also take a psychological toll on your well-being. Some people become fearful of discomfort after bowel movements and try to avoid having them. Ignoring the urge to have a bowel movement can lead to constipation and other complications.

Fissure treatments

Fissures often heal without treatment, but non-surgical treatments can help them heal faster.
Non-surgical treatments for fissures may include changes in your diet, such as increasing your fluid intake and eating high-fiber foods, which can make stool softer and easier to pass. You may also need to apply a cream around the anus to allow the muscles to relax. Doing so increases blood flow and promotes healing. Find out more about our treatments.

If non-surgical treatments are not successful, you may need a procedure to help anal muscles relax. These procedures include:

• Botox injections: Botox injections for fissures relax the band of muscles controlling your anus (sphincter) and increase blood flow to the area, which helps it heal. Unlike cosmetic Botox injections that provide temporary results, Botox injections for fissures provide long-lasting relief.
• Lateral internal sphincterectomy: Sphincterectomy is a surgical procedure that relieves tension in the muscles of the anal sphincter while still allowing you to control bowel movements. The goal of the procedure is not to close the fissure, but to relax the muscles, which provides the best long-term result.
• Anoplasty (anal advancement flap): If other treatments fail to heal the fissure, you may need another surgical procedure. During anoplasty, we bring healthy tissue from outside the anus and cover the fissure.

An abscess is a pocket of infected tissue (pus) that forms near the anus. Having an abscess can be painful and make it difficult to perform tasks that were once simple, such as sitting down or having a bowel movement. Some people also experience fever and chills. Abscesses usually form as an infection from an anal gland.

We are often able to diagnose an abscess with a simple visual examination. Sometimes we use a special tool (anoscope) or a gloved, lubricated finger (digital rectal exam) to get a better view of the affected area.

Abscess treatments

We treat abscesses through an in-office procedure that allows the pus to drain.

Some abscesses return after treatment. There many reasons an abscess may not go away, including other medical problems or an incomplete drainage. Our team's depth of expertise helps us accurately determine why an abscess has come back so you can get additional treatments without delay.

If you have had an abscess for a long time or pus continues draining after treatment, a fistula may form. Fistulas happen when the pus burrows into surrounding tissue, forming an abnormal connection between your rectum and a nearby organ. In women, fistulas can form between the rectum and vagina. In men, they can form between the rectum and the duct that connects the bladder to the penis (prostatic urethra).

Fistula symptoms may include irritation, pain, swelling and possible fluid drainage. You may also notice blood or pus after having a bowel movement. We offer a broad range of diagnostic imaging tests, including ultrasound and MRI to determine the precise start and end points of the fistula, which helps us deliver prompt, effective care. Most times, we are able to detect fistulas and map their course during a comprehensive exam we perform while you are asleep (under anesthesia).

Fistula treatments

Fistula treatments usually require surgery to drain the pocket of pus. A second surgery may be necessary to fix the fistula. Treating a fistula as quickly as possible can reduce your risk of additional infection and complications.

Our team offers a broad range of fistula treatments. We work with you to discuss your options and help you choose the procedure that best meets your needs and preferences. Learn more about our treatments.

Surgical fistula treatments include:

• Fistulotomy: We make an incision along the entire length of the fistula, which allows it to heal on its own.
• Fistula plug: An anal fistula plug is made up of dissolvable material that promotes the natural development of tissue to heal the fistula. The plug usually disappears within 6 to 8 weeks.
• Anoplasty: During anoplasty, we bring a flap of healthy tissue from the lining of the rectum (transanal advancement flap) or the skin around the anus (anocutaneous advancement flap) to cover the fistula opening within the rectum. Anoplasty is a procedure we perform in the operating room, but you can expect to go home the same day.
• Ligation internal fistula tract (LIFT procedure): During a LIFT procedure we pinpoint the fistula tunnel then cut and tie it off. This procedure reduces the risk of damage or disruption to surrounding tissue. We perform the LIFT procedure in the operating room, but you can expect to go home the same day.