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An anal fistula, is also called as fistula- in -ano, it is a small channel that develops between the end of the large intestine called the anal canal and the skin near the anus. This is a painful condition, especially when the patient is passing stools. It can also cause bleeding and discharge during defecation.
Genesis of fistula-in-ano
Almost all anal fistulae occur due to an anorectal abscess that begins as an infection in one of the anal glands. This infection spreads down to the skin around the anus causing fistula-in -ano. The anorectal abscess usually leads to pain and swelling around the anus, along with fever. Treatment for anorectal abscess involves incising the skin over the abscess to drain the pus. This is done usually under local anesthesia. A fistula-in-ano happens when there is failure of the anorectal abscess wound to heal completely. Almost 50% of patients with an abscess go on to develop a chronic fistula-in-ano.
- Pain- Constant pain which gets worse when sitting down
- Irritation around the anus, like swelling, redness and tenderness
- Discharge of blood or pus
- Constipation or pain while evacuation
A clinical evaluation, including a digital rectal examination under anesthesia, is carried out to diagnose anal fistula. However, few patients may be advised screening for rectal cancer, sexually transmitted diseases and diverticular disease.
The only cure for an anal fistula is surgery. The type of surgery will depend on the position of the anal fistula. Most patients are treated by simply laying open the fistula tract to flush out pus, called Fistulotomy. This type is used in 85-95% of cases and the fistula tract heals after one to two months.
- Seton techniques: A seton is a piece of thread (silk, plastic) which is left in the fistula tract to treat anal fissures. This is used if a patient is at high risk of developing incontinence after fistulotomy.
- Advancement flap procedures: When the fistula is considered complex, carrying a high risk of incontinence, then this advanced technique is used.
Other techniques like Fibrin glue and Bioprosthetic plug are also used to surgically treat anal fistulas. In the Fibrin glue technique, glue is injected into the fistula to seal the tract, after which the opening is stitch closed. Bioprosthetic plug is a cone shaped plug made from human tissue, which is used to block the internal opening of the fistula. After this stitches are used to keep the plug in place.
Whatever the surgical technique, one can experience minor changes in continence. Patients usually don’t require antibiotics after surgery but have to take pain medication. They may also have to use gauze to soak up drainage from anus. After surgery, patients should seek help if they have increased pain or swelling, heavy bleeding, difficulty in urination, high temperature, nausea or constipation.
Our endocrine glands work overtime to keep us healthy by secreting hormones which reach each and every cell in our body through the blood. These hormones evoke life changing responses in other cells to keep us alive and healthy. Endocrine surgery is a term for an operation in any one or more endocrine glands in your body.
Types of endocrine glands
- Thyroid gland: This is the most important endocrine gland in your body and it secretes thyroid hormone, which regulates metabolism.
- Parathyroid glands: There are 4 parathyroid glands and these are located behind the thyroid gland in the neck region. These glands secrete the parathyroid hormone which controls calcium levels in the body.
- Adrenal glands: These are located over the kidney. There are 2 adrenal glands and these secrete adrenaline, aldosterone and cortisol- the body’s fight or flight hormone. These also maintain salt levels in the blood and the blood pressure.
- Neuroendocrine glands of the pancreas: These are located in the pancreas behind the stomach. They work to control glucose levels and glucose metabolism.
- Pituitary gland is the master gland of the body: It secretes thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), and other important hormones that control ovaries, thyroid and other endocrine glands in your body.
- Hypophysectomy: This is the surgical removal of the pituitary gland. It is a very sophisticated and critical surgery that surgeons resort to, if there is a tumor in the pituitary gland - especially craniopharyngioma tumors. It can cause atrophy of thyroid, adrenal glands and the ovaries as the pituitary secretes hormones to control their function. In addition, it can result in sterility and sometimes results in a non-functional reproductive tract in both men and women.
- Thyroidectomy: It is an operation that involves removal of the entire or parts of the thyroid gland in the neck. Trained ENT or endocrine surgeons perform this operation, which is indicated for thyroid cancer or hyperthyroidism, goiter or Graves disease. Sometimes it is done for treating an enlarged thyroid gland or obstructions in the neck region, causing problems in swallowing or breathing. In cases of total thyroidectomy patients will need life long thyroid hormone supplementation. Sometime patient can have change in voice which is usually temporary.
- Since the thyroid produces several hormones like thyroxine (T4), triiodothyronine (T3), and calcitonin, you will have to take oral synthetic hormones all your life post surgery. The thyroid is usually removed through an incision in the neck. These days there is the option of minimally invasive surgeries too.
- Adrenalectomy: It is the removal of one or both adrenal glands to treat tumors of the adrenal glands. It is done using an open incision or laprascopic technique.
- Pinealectomy: It is a surgical procedure in which the pineal gland is removed.
Many women experience a temporary encounter with hemorrhoids when they are pregnant. Quite surprisingly, most people tend to experience this in their daily lives. By the age 50, majority of people have encountered one or more symptoms of this ailment, including rectal pain, bleeding, itching and may be prolapse where the hemorrhoids protrude out of the anal canal. Though this ailment can be rarely detrimental, it can be a painful intrusion. But thankfully, there are a lot of things we can do about them.
How may this be diagnosed?
Hemorrhoids are usually diagnosed from a plain medical history and health exam. External hemorrhoids, more commonly known as piles, are normally apparent, particularly if a blood clot is formed. Your physician shall perform a digital rectal test to detect blood in the stool. Then the physician may also inspect the anal tube with the aid of an anoscope, which is a short plastic channel interjected into the rectum with illumination. If he finds any evidence of microscopic blood or rectal bleeding in the stool, then there may be a need to perform colonoscopy or flexible sigmoidoscopy to determine the probable causes of bleeding like cancer or colorectal polyps, specifically in women aged over 50.
Is it possible to treat hemorrhoids at home?
Most of the common symptoms of piles can improve drastically with simple in-home measures. If you are suffering from occasional flare-ups, you may try the following:
- Eat a lot of fibre: It is recommended to add fibre in the diet; may be a fibre supplement like Citrucel, Fibre con, etc. When you drink a lot of water along with loads of fibre, stools get softened making them effortless to pass, which will reduce the pressure on the swollen veins. Eating broccoli, wheat, oats, beans, fresh fruits every day will help in decreasing bleeding caused due to piles. It also reduces swelling and inflammation. If you feel digestive issues with a sudden splurge of fibre in your diet, you may start slowly and gradually increase the amounts.
- Take a sitz bath: A sitz bath is a lukewarm water bath for the lower back portion of the body, which can help in relieving irritation, itching as well as spasms occurring in the sphincter muscle. You can either get small plastic tubs for a sitz bath or sit in a normal bath tub. Most physicians suggest a half an hour sitz bath after every bowel movement. Then tenderly dry the area and avoid wiping it hard.
There are several invasive treatments that can be opted if these conservative treatments are not able to help your condition. In such an instance, it is always wise to seek advice of a medical practitioner.
The gallbladder is a very important organ in the human body. This is a pear-shaped organ which is used for storing the bile. Bile is a fluid which helps in digesting your food. When the gallbladder does not function well, then hard fragments will form in the gallbladder and they are calledgallbladder stones. The size of these stones differs from person to person. For a few people, they are just the size of a small rice grain and for few, it can be as large as a golf ball.
When gallbladder stones are formed, they will not vanish by themselves. They will cause pain and many other symptoms which are unbearable. You need to consult a doctor and you may have to get the gallbladder removed. This kind of gallbladder removal surgery is called cholecystectomy.
How are gallbladder stones removed?
More than 80 percent of people with gallbladder stones will need a cholecystectomy. This surgery can be performed in two different ways.
- Open gallbladder surgery: In an open gallbladder surgery, a 5-inch incision is made in the abdominal area which is not required for a laparoscopic surgery. Nowadays, people are opting for laparoscopic surgery for any kind of surgery as it is safe, less painful, requires a shorter stay at the hospital and there are fewer scars.
- Laparoscopic gallbladder surgery: In a laparoscopic gallbladder surgery, 4 small incisions are made in the abdominal area. A small tube with a very small camera and light will be inserted into the abdomen through one of the incisions made. Equipment required for the removal of the gallbladder is also inserted through the other incisions and the surgery is performed.
Before performing the laparoscopic gallbladder removal surgery, you will have to undergo a few tests such as blood test, complete physical test, gallbladder imaging tests and a review of your past medical history. After going through the reports of all these tests and checking all other medications that you take, your doctor will decide if you need gallbladder surgery or not.
Post Gallbladder surgery: Post-surgery, you may see some symptoms, but they are rare and mild. One of the common symptoms experienced after the surgery is diarrhea. You can start walking as soon as you start feeling better. But you should talk to the doctor in order to get back to your normal routine.
Regarding your diet, you will have to start with a liquid diet and make sure that you do not take heavy and fatty food. Your body will take some time to get back to digesting a normal diet and hence you will have to take good care.
I have two question. I want to know lipoma removal by surgery is suggested or the person can continue with it. The another question is about varicose vein surgery is required or not.
Does there be a risk of anal scar tissue getting developed after stapler surgery for internal haemorrhoids and for anal stricture? I had done one surgery for third-grade piles, using laser technology. But after surgery, there is scar tissue formed inside the anus. And also due to anal stricture, narrow of anal hole. Is there any risk of getting another scar tissue developed if staple surgery is done to push internal haemorrhoids back and for anal stricture?
Bariatric surgery is a surgery performed on the stomach and is usually recommended for people who are obese. If you have a BMI value more than 40, then this surgery is a very good option. Along with those having an obesity problem, this surgery is also said to be ideal for those people who are suffering from type 2 diabetes and having a BMI value between 35 to 40.
There are many studies which show that there is a great improvement in people with type 2 diabetes after bariatric surgery. Even the cholesterol and blood pressure levels can also be controlled with the help of this surgery. Post-surgery, you will have to take fewer medicines or in some cases, you need not have to take medicine at all.
How does the doctor decide if you need bariatric surgery?
Basically, there are two things that will be considered by the doctor. The first one is the BMI value, which should be above 35. And the second parameter to consider is if you have tried any other methods to lose weight but did not succeed. Based on these and if you are ready to face the mental and physical challenges after the surgery, you will be advised to go through this surgery. You should make sure that you are doing regular exercise and also eat less.
Types of bariatric surgeries for type 2 diabetes
- Gastric bypass: In this kind of surgery, the stomach is divided into two parts. One small part at the top is separated from the lower part of the stomach. Whatever you eat, will go into this small part of the stomach and that makes you feel full faster. Also, fewer nutrients and calories are absorbed into the body. After this kind of surgery, more than 80 percent of diabetes patients showed no signs of diabetes at all.
- Gastric sleeve: In this surgery, a large portion of the stomach is removed and hence you will be able to eat less. This also reduces the amount of ghrelin, the hormone responsible for making you feel hungry, produced. This is successful in 60 percent of people with type 2 diabetes.
- Adjustable gastric band: A small inflatable band is placed around the stomach. This will look like a small pouch at the place where the food goes in. This pouch will get full a lot quicker and hence you will not be able to eat too much.
Does it help?
Some surgeries show 80 percent success rate and some show 60 percent success rate, but that is in terms of diabetes levels. Due to less food, the body will not get the required minerals and vitamins, which will result in other health complications. Some surgeries are also irreversible. So, it is your doctor who understands the surgery and your health better and they will always suggest the best option for you. In case you have a concern or query you can always consult an expert & get answers to your questions!
Rectal cancer is the growth of cancerous cells in the rectum, which is the colon’s lower part of the colon, connecting the large bowel and the anus. The basic function of the rectum is to collect the stool that is formed inside the human body before it is eliminated from the body. The cancer starts as a polyp, which is precancerous, and slowly develops and turns cancerous. This cancer will start spreading and penetrates into the walls of the rectum causing rectal cancer.
Surgery is the most common treatment available for rectal cancer. Depending on the location of the cancer and the type of cancer, there are different types of rectal cancer surgeries available. One of the important things that are considered before deciding which kind of surgery is required is the location of the tumor from the anus.
Types of Surgeries for Rectal Cancer:
Here are different types of surgeries available for different stages of rectal cancer.
- Low Anterior Resection Surgery: When the cancer or the tumor is located above the anus, then low anterior resection surgery is the best surgery. The rectal cancer, adjoining rectal tissues and the lymph nodes are removed. This surgery is done by making an incision in the lower part of the abdomen. This surgery is used for stage 1 cancer.
- Abdominoperineal Resection Surgery: Abdominoperineal resection surgery is preferred when the tumor is close to the anus. It can be used for treating stage 1 cancer and also can be used for stage II and stage III as well. The rectal cancer, the anus, adjusting rectal tissues and the lymph nodes are removed.
- Local transanal resection: When the cancer is in its early stage and is not far from the anus, your surgeon will opt for local transanal resection surgery. Usually, the tumor has to be small for performing this surgery.
- Proctectomy with colo-anal anastomosis: You may have to remove the entire rectum if the tumor is present in the middle or lower part of the rectum. This is usually in stage II or stage III. This kind of situation requires proctectomy with colo-anal anastomosis.
- Transanal endoscopic microsurgery: When the tumor is above the rectum and is in its early stage, transanal endoscopic microsurgery is the best method. But for performing this surgery, experts with special equipment are required.
- Pelvic exenteration: When the rectal cancer starts growing to the organs near to rectum, pelvic exenteration is required. This is a time consuming major surgery. Usually, along with the rectum, other organs such as the bladder, uterus or prostate is also removed. The patient will take months to recover from this major surgery.
In case you have a concern or query you can always consult an expert & get answers to your questions!