Common anorectal conditions include hemorrhoids (piles, swollen blood vessels around the back passage), anal fissure (a small tear in the skin of the anus) and anal fistula (a small tunnel between the inside of the anus and the skin nearby). Treatment of anorectal conditions often starts with simple steps such as better bowel habits and diet, while some need a procedure or surgery. In Amman, a calm, private examination finds the cause and the right option.
Note: Bleeding from the back passage or a change in bowel habits is not always piles. See a doctor to find the cause, and go to the emergency department straight away if the bleeding is heavy, or if you have severe pain with fever and swelling around the anus.
Symptoms
Symptoms depend on the problem and may include:
- Bright red blood on the toilet paper or in the toilet after a bowel movement
- A lump or bulge at the anus that may come out and go back in (hemorrhoids)
- Itching or irritation around the anus
- Sharp pain during and after passing stool that may last a while (anal fissure)
- Discharge from a small opening in the skin near the anus, or repeated abscesses (fistula)
- Pain, swelling and fever around the anus, which may be an abscess needing urgent care
Causes
- Hemorrhoids: linked with long-term constipation, straining, sitting on the toilet for long, pregnancy and being overweight
- Anal fissure: often caused by hard stools or repeated diarrhoea; the pain can make the anal muscle spasm, which slows healing
- Anal fistula: usually forms after an abscess near the anus that did not fully heal
- Some inflammatory bowel diseases can be linked with fissures or fistulas
- Too little fibre and fluid in the diet makes constipation more likely
Diagnosis
Diagnosis starts with a talk about your symptoms, then a gentle examination of the area in full privacy. Your doctor will explain each step before doing it.
Depending on your case, your doctor may request further tests, especially if there is bleeding or a change in bowel habits, to make sure there is no other cause.
- External examination and, when needed, a finger examination or a short anal scope
- A colonoscopy in some cases, depending on age and symptoms
- An MRI or ultrasound scan for some fistulas
Treatment options
Treatment depends on the type and severity of the problem. Options are listed from the simplest to the most invasive:
The right option depends on your examination and how severe your symptoms are. Your surgeon will explain what suits your case.
- ### Hemorrhoids
- Diet and lifestyle changes: more fibre and water, no straining and no long sitting on the toilet. This is the first step in most cases.
- Creams or other local treatments prescribed by your doctor to ease symptoms.
- Simple procedures for some internal hemorrhoids, such as rubber band ligation or injections, depending on your doctor's assessment.
- Surgery: for some large hemorrhoids or those that have not improved with simpler options.
- ### Anal fissure
- Softening stools with fibre and fluids, and sitting in warm water to ease pain and spasm.
- Local treatments prescribed by your doctor to relax the anal muscle and help healing.
- Injection or surgery: for a long-standing fissure that has not healed with simpler treatment, depending on your surgeon's assessment.
- ### Anal fistula
- Treating any abscess first by draining it.
- Surgery: a fistula does not usually heal with medicines alone. The type of surgery depends on the fistula's path and its relation to the anal muscles, with care taken to protect bowel control.
What to expect on the day and after
Simple procedures may not need a hospital stay. Operations are usually done under anaesthetic, and many patients go home the same day, depending on their case.
- You may feel pain or discomfort in the area, especially with the first few bowel movements
- Plenty of fibre and water helps keep stools soft and eases pain
- Sitting in warm water may soothe the area if your doctor advises it
- Some light bleeding or discharge may happen at first
- Recovery time varies, and your surgeon will explain what to expect in your case
- Contact your doctor if you have heavy bleeding, fever, worsening pain or trouble passing urine
When to book an appointment
Book an examination if you notice:
- Bleeding from the back passage, even if light
- Pain when passing stool that keeps coming back or does not improve
- A lump or bulge at the anus
- Discharge or repeated abscesses near the anus
- A lasting change in your bowel habits
- Symptoms that have not improved with diet and bowel-habit changes