Proctology

Proctology is an area of Surgery dedicated to the diagnosis and treatment of benign and malignant diseases of the anal canal and of the perianal region.

Common Symptoms

The most frequent proctological or anorectal symptoms are:

• Blood loss – Haematochezia – Haemorrhage;
• Rectal pain;
• Rectal mucus or pus; 
• Itching;
• Defecation alterations – dysphasia, faecal incontinence.

Main Pathologies / Diseases 

There are various Proctologic (Anorectal) benign diseases, the most common being Haemorrhoidal Disease and Anal Fissures. These deserve a special mention due to their important prevalence among young people. There are other diseases such as Anal Fissure, Perianal Fistula, Anal Fibroids and Rectal Prolepses (rectal invagination towards the anal canal). Faecal Incontinence, Perianal Condyloma (associated with HPV infection).

Internal Haemorrhoid Disease

These occur when there is congestion of the upper haemorrhoidal piles. Defecation effort, an increase in intra-abdominal pressure, the absence of valves in the vessels of the haemorrhoidal piles, chronic constipation, the vertical position of the human being and genetic factors might all be involved in the development of haemorrhoidal disease. The most common symptom of this disease is (red) blood loss during or after defecation. 

The haemorrhoidal disease can be classified into various degrees, which will then determine different treatment options:

• Internal Haemorrhoidal Piles: anal haemorrhaging without prolapse
• Internal Haemorrhoidal Piles grade ll: with anal prolapse but reduces spontaneously
• Internal Haemorrhoidal Piles grade lll:  with anal prolapse but manual reduction is necessary
• Internal Haemorrhoidal Piles grade IV: with anal prolapse where reduction is not possible
   

Anal Fissure

These are small oval ulcers, normally situated  in the lower part of the anal canal. The main symptom is extreme and intense, penetrating pain when defecating, which may continue for several hours. Fear of a new painful defecation leads to chronic constipation. This then results in a “vicious circle”: Pain  ► Fear of defecation ► poor blood supply ► Poor healing ► persistent fissure.
 

Anal Fistula

These are sometimes complex situations and typically arise after an anal abscess. A fistula connects the canal to the skin. Fistulas are confirmed due to their purulent appearance as open wounds.
 

Anal Fibroids

Abnormal fibrous tissue, which often indicates chronic proctologic diseases. These lesions are benign but often symptomatic (Pain/anal discomfort, inflammation, hygiene difficulty). Minimally invasive surgery may be necessary, which can be carried out in the Out-Patient Proctology Consultation.
 

Anal and Perianal Warts

Growths/legions around and/or inside the anus, associated with HPV Infection that should be eliminated in order to prevent malignant progression of the lesions. The type of treatment depends on the location and size of the lesions.

Surgeries / Procedures Performed in the HPA Health Group

In the Out-Patient Proctology Consultation a diagnosis is reached after identifying the patients symptoms and after the following examinations:

• Physical examination of the anal and perianal region.

After a diagnosis is reached the patient is referred to the most appropriate treatment. The most common procedures depending on the diagnosis might be:

Internal Haemorrhoids

The appropriate treatment depends largely on the extent of the disease. For internal Haemorrhoids Grade I to IV, the treatment may be performed in the consulting room through Haemorrhoid Sclerosis and/or Elastic Haemorrhoidal Ligation. The most advanced cases (Grade IV) surgery might be necessary - Haemorrhoidectomy.
 

Fissures

For acute Fissures, conservative medical treatment is indicated, which is changing eating habits, consisting of a diet rich in fibre and drinking more water, as well as increasing the fluid intake and applying healing ointments. If conservative treatment does not solve the problem Chronic Fissures might need treatment with Botolinum Toxin Injection, Fissurectomy and Fistulotomy.
 

Anal Fistula

The treatment implies the introduction of a drain in the path of the Fistula and in some cases a Progressive Fistulotomy is necessary.

Necessary Examinations

We have varied and differential technology for the support of diagnosis and treatment in Proctology, as well as other examinations and specialties for the follow-up treatment. 

• Colonoscopy;
• Endoscopy;
• Abdominal Ultrasound;
• Abdominal CT Scan;
• Pelvic CT Scan;
• Laboratory Tests;
• Anoscopy;
• Rectosignoidoscopy;
• Flexible Sigmoidoscopy.

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