In proctology, diseases of the rectum and anus are treated. As head of the proctology departments at the Frauenfeld Cantonal Hospital and the Zurich City Hospital, Dr A. Scheiwiller has gained in-depth experience in this field. We are very pleased that we can now also share this experience with the patients of Swiss1Chirurgie.
Which diseases belong to proctology?
Proctological diseases are very common. Among the best known are haemorrhoids, fissures or fistulas. But functional disorders such as constipation, defecation disorders or faecal incontinence also belong to the exciting field of proctology.
Haemorrhoids are enlarged vascular cushions in the anal canal. The pads are present in all people – we only speak of haemorrhoids when they are too large and cause symptoms. Haemorrhoids are very common and are encouraged by hard bowel movements and prolonged sitting. The disease often progresses in episodes, which means that the symptoms can increase and decrease over time. With small haemorrhoids, good stool regulation is often enough to achieve a soft bowel movement. In addition, ointments help to alleviate the symptoms. Above a certain size, however, surgery is often unavoidable for a sustainable therapy.
Typical symptoms of haemorrhoids are blood in the stool, anal itching, foreign body sensation anally or leaking mucous membrane. A doctor should always be consulted for these symptoms – firstly to receive appropriate therapy and secondly to be able to rule out a more dangerous disease of the rectum.
Haemorrhoids are actually harmless, but they can be extremely annoying and lead to a significant reduction in quality of life.
Possible operations for enlarged haemorrhoids:
1-4 Tip resection according to Ferguson:
The enlarged haemorrhoidal cushions are excised and the mucosa is closed again. At the transition to the skin, the wound is left open to allow good drainage of wound fluid.
Haemorrhoid surgery according to Longo:
A ring of mucosa is cut away with a stapler. This pulls the haemorrhoids inwards and reduces their size.
Fissures are small tears in the mucous membrane directly between the anus and the skin. They are very painful and can also bleed easily. They can often be healed with good stool regulation and ointments that relax the sphincter muscle. If a fissure does not heal within 6-8 weeks, it should be excised in a minor operation to allow healing.
Fistulas are connections from the rectum to the skin. They usually occur as a result of an abscess on the anal verge. They are very annoying and should definitely be treated, otherwise inflammation and thus damage to the sphincter muscle can occur again and again.
Behind a defecation disorder there is often a mechanical obstruction, for example an internal or external rectal prolapse or intestinal prolapse. In this case, the rectum bulges into itself, which can lead to obstruction of bowel movements. Prolapse can be treated with laparocsopic surgery. This involves stretching the rectum with the help of a plastic net and allowing the stool to be emptied.
In the case of incontinence, the sphincter muscle must first be examined. If there is enough muscle, biofeedback therapy (a type of physiotherapy) can often achieve a significant improvement in continence. Otherwise, there are treatment options by suturing the sphincter muscle or by installing a neurostimulator (a type of pacemaker), which improves the function of the sphincter muscle.
We look forward to advising you in a personal and pleasant setting at the Swiss1Chirurgie clinic and finding the best possible therapy for you.