Conditions We Treat

Conditions We Treat

Hemorrhoids

Why it happens:

Swollen veins (cushions) in or around the anus caused by constipation, straining, pregnancy, obesity, or prolonged sitting.

Symptoms:

• Bleeding during bowel movements
• Pain, itching, or swelling around the anus
• A lump or feeling of fullness

Diagnosis:

Physical exam, anoscopy, or proctoscopy to determine the grade (1–4).

Treatment: see Haemorrhoids tab for all treatment options.

• Conservative: creams, fiber intake, hydration
• Minimally invasive surgery: laser, THD, or band ligation
• Surgical: hemorrhoidectomy for advanced cases

Why it happens:

A small tear in the anal lining, often from passing hard stools or chronic constipation.

Anal Fissures

Symptoms:

• Sharp pain during or after bowel movements
• Bright red bleeding
• Spasms of the anal sphincter

Diagnosis:

Visual examination by a specialist.

Treatment:

• Conservative: stool softeners, topical ointments, suppositories
• Advanced: Botox or PRP injections (platelet rich plasma) to relax the muscle
• Surgical: laser anal fissurectomy, anal dilatation, endorectal advancement flaps, lateral sphincterotomy for chronic fissures

Anal Fistulas

Why it happens: An abnormal tunnel forms between the anal canal and the skin, usually following an infection or abscess (90% result from non-specific cryptoglandular infection).

Symptoms:

• Persistent discharge or pus +/- bleeding
• Pain and swelling around the anus
• Recurrent abscesses

Diagnosis:

Physical examination, MRI, or endoanal ultrasound.

Treatment:

• Sphincter-preserving anal fistula repair
• Laser fistula closure (FiLaC)
• VAFT (Video-Assisted Anal Fistula Treatment)
• LIFT (Ligation of the Intersphincteric Fistula Tract) 
• Seton placement for complex fistulas
• Fistulotomy or fistulectomy
• Lay-open technique
• Anorectal advancement flaps
• Fibrin glue, biological injectables (eg.: Permacol)

Anal Polyps

Why it happens:

Small growths inside the anal canal, sometimes linked to inflammation or colon polyps. May carry a small risk of malignancy.

Symptoms:

• Bleeding during bowel movements
• Mucus discharge
• Occasional discomfort or protrusion

Diagnosis:

Detected during proctoscopy, sigmoidoscopy, or colonoscopy.

Treatment:

• Endoscopic or surgical removal
• Biopsy to rule out malignancy AIN (Anal Intrepithelial Neoplasia) 

Anal Skin Tags

Why it happens:

Soft, flesh-colored growths around the anus might develop due to viral infection (Herpes simplex virus, HPV Human Papilloma Virus, molluscum contagiosum, HIV) or anal contact. Sexually transmitted diseases need to be taken into account. Sometimes they are only residual external hemorrhoidal skin tags – therefore expert opinion needed to achieve differential diagnosis.

Symptoms:

• Small soft, sometimes painful lesions around the anus with +/- bleeding and itching
• Mild itching or irritation
• Cosmetic concern

Diagnosis:

Visual inspection during examination. Biopsy to exclude condyloma or other diseases. Dermatology opinion. Gynecology opinion if needed.

Treatment:

• Simple excision or cryotherapy under local anesthesia
• Extensive cases might need examination under anesthesia with excision or biopsy
  Post-care includes hygiene and topical soothing agents

Perianal / Anal / Ischiorectal / Horseshoe Abscess

A painful collection of pus that forms due to infection in anal glands. Depending on the spread, it may extend into deeper spaces like ischiorectal or horseshoe configurations.

Why it happens:

Usually cryptoglandular infection, Crohn’s disease, or untreated anorectal inflammation.

Symptoms:

• Severe throbbing pain
• Swelling and redness
• Fever or chills
• Possible discharge
• Bleeding 

Treatment:

Urgent incision and drainage, or imaging-guided aspiration. Delayed treatment may lead to sepsis, prolonged hospitalization, or the formation of an anal fistula.

Perianal / Anal / Ischiorectal / Horseshoe Abscess

What it is:

A collection of pus caused by gland infection in the anal canal. It may spread into deeper spaces such as the ischiorectal or intersphincteric compartments.

Why it happens:

Usually due to cryptoglandular infections, Crohn’s disease, or untreated fissures.

Symptoms:

• Severe throbbing pain
• Swelling, redness
• Fever or feeling unwell
• Possible discharge

Treatment:

Urgent drainage is required. Failure to treat early can lead to chronic anal fistula formation.

Pilonidal Sinus & Pilonidal Abscess

These two conditions are often confused, even in clinical settings. Why confusion happens: Many patients (and even clinicians) confuse these two. A pilonidal sinus is a chronic condition, whereas a pilonidal abscess is an acute infection.

Pilonidal Sinus (Chronic Condition)

A small tract under the skin near the coccyx, caused by trapped hair and chronic inflammation.

Symptoms:

• Recurrent discharge
• Pain when sitting
• Chronic irritation

Pilonidal Abscess (Acute Condition)

A painful abscess filled with pus, around the tailbone area. 

Symptoms:

• Severe pain
• Swelling and redness
• Fever

Treatment for Both:

• Abscess drainage
• Laser hair removal (adjuvant)
• Definitive surgical options, using minimally-invasive technique and laser surgery 
• Hygiene & wound care guidance