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Pilonidal Sinus (PNS) is a disease in which hairs slip into the cleft above the buttocks and develop into the sinus. It is a small hole or tunnel in the skin. PNS consists of dirt, debris and hair. Pilonidal Sinus may cause severe pain when infected. If it gets infected, it may ooze blood, pus, and have a foul smell. The infected part may also get inflamed.
The term Pilonidal is derived from Latin; pilo means hair and nidal means nest. It generally occurs in adult men who sit for prolonged periods like taxi or truck drivers and now a days people sitting in chair for hours together like software people.
Causes of Pilonidal Sinus
One of the main causes that lead to Pilonidal Sinus is “friction of hair & the seat over the buttocks. The body considers buttock hairs as foreign hairs; in response to these hairs, the body launches an immune system that forms a cyst around them. These cysts can multiply with time as well.
● Change of hormones after puberty
● Growth of unwanted hair
● Friction while sitting or walking
● Prolonged sitting
Risk Factors of Pilonidal Sinus:
Generally Pilonidal Sinus is seen in men with dark and coarse body hair. Some of the other factors that may lead to PNS are increased sweating, buttock friction, prolonged sitting, inactive lifestyle, poor hygiene, obesity, and local trauma. Recognizing Signs of Pilonidal Sinus Infection Some of the symptoms by which one can identify and distinguish Pilonidal Sinus from other anorectal diseases are:
● Low fever
● Swollen cyst
● Pain while sitting or standing
● Sore and reddened skin around the cleft
● Blood or Pus oozing out from the cleft
● Foul odour from infected area
● More sinus tracts over a period of time
● Hair protruding from the area
● Holes in the skin
How Pilonidal Sinus is Treated?
At an early stage when the patient doesn’t experience pain or inflammation, the doctor will recommend a broad-spectrum antibiotic. This will help treat a wide range of bacteria. This antibiotic will not heal the cyst but provide relief from discomfort and infection. At such stages doctors may also recommend patients to get MRI examinations, shave hair regularly, and pay proper attention to personal hygiene.
Surgery is the treatment for pilonidal sinus. It has high chances of recurrence, therefore there are many surgical methods to treat this condition. It requires thorough debridement and cleaning of the sinus. There are many plastic surgeries to close the opened area. All methods take 8 to 10 weeks for healing. Laser Pilonidotomy is one of the best way to treat the condition as it does not involve any suturing and patient can go home same or next day. It can also be done under local anaesthesia.
A hernia occurs when any organ of the body pushes through an opening in the muscle that holds it in place. Hernias are one of the most common problems that occur in the abdomen. Hernias can also appear in groin areas, upper thighs and belly buttons. They are not life-threatening, but they don’t go away on their own.
These are some of the common types of Hernias:
● Groin hernias: They are Inguinal, Femoral or Obturator hernias. These are one of the most common types of hernia. They constitute about 70 percent of total hernias. They are more commonly found in men than in women. Femoral hernia is common in females. Inguinal hernias occur when intestine is moved through a weak spot in the lower abdominal wall.
● Umbilical hernia: This occurs in children and babies under 6 months old. This happens when their intestines bulge through their abdominal wall near the belly button. This is the only kind that goes away on its own.
● Incisional hernia: It can occur after having abdominal surgery. Hernia occurs through the defect in the suture line.
● Hiatal hernia: It occurs when part of the stomach extends up through the diaphragm into the chest cavity. These are most common in people above 50 years of age.
Causes of Hernia
The problem of Hernia occurs due to the combination of straining and muscle weakness in the body. Depending on its cause, it can grow over a short period or a long period of time. Common causes of Hernia are listed below:
● Sudden weight gain.
● Hernia may occur through the defect in the incision of previous surgery.
● It is caused when there is increased intra-abdominal pressure like in straining for urination or for passing stool.
● It may occur in pregnancy, as abdominal muscles are stretched.
● If a person is lifting heavy weight during exercise.
Symptoms of Hernia
The most common symptom is a bulge or lump in that area. Other common symptoms are listed below:
● Feel discomfort or dragging pain in the abdomen.
● Feeling of heaviness in the groin.
● Feel an aching sensation at the site of the bulge.
A person suffering from hernia might experience one or more of the above symptoms.
Treatments for Hernia
It is usually diagnosed through a physical examination. Whether or not a person needs treatment depends on the symptoms and size of the hernia. Some of the treatment modalities of hernia are listed below:
● A change in diet can effectively treat many symptoms of hiatal hernia.
● Some medications can lessen the amount of pain and reduce stomach acid, in case of hiatus hernia.
● If the hernia grows in size, then one has to go through surgery.
One can have either open or laparoscopic surgery. During surgery, after reduction of hernia surgeon needs to strengthen the weak abdominal wall. It is done by using Polypropelene Mesh. It may be a single dimensional or 3 dimensional Mesh. Let your treating surgeon decide about the treatment modality best suited for you.
Piles are also known as Hemorrhoids. These are normal cushions of the anal opening. When they swell they are called as piles. Piles contain supportive tissue, blood vessels, muscle and elastic fibers. Piles occur due to increased intra-abdominal pressure such as due to constipation, lifting heavy weights, etc. Piles can be graded on a scale from I to IV:
● GRADE II: These are larger than grade I, but they may protrude out while passing the stool and retract back into the body upon completion of bowel movement.
● GRADE III: These appear outside the anus and one can feel them hanging from the rectum.it does not retract of its own but they can be easily re-inserted.
● GRADE IV: Grade IV piles can not be pushed back. It needs treatment. They are huge and remain hanging outside the anus.
In some of the cases, the signs of piles are not very serious and normally resolve within a few days on their own. An individual suffering from Piles can experience one or more of the following:
● A lump can be felt around the anus and it may contain blood.
● After passing stool, patient still feels that the rectum is full.
● The area around the anus is itchy and red.
● There may be mild to moderate pain while passing a stool.
● If the piles are severe, one will experience excessive anal bleeding.
Causes of Piles
Piles are caused by an increase in pressure in the lower rectum. This may occur:
● When one passes a stool less than 3 bowels in a week, that leads to chronic constipation.
● When one passes a loose stool for around 4 weeks, that leads to chronic diarrhoea.
● If a person is lifting heavy weights during exercise or any other work.
● It can happen at the time of pregnancy.
● It can also happen when one is forced to pass a stool.
● It can also happen as a consequence of cancer in the lower part of large bowel.
Treatment of Piles
A doctor can usually diagnose piles after going through a physical examination or even a digital rectal examination. In most cases, it resolves on its own. However, some treatments are there which lessen the itchiness. Some of the popular ones are listed below:
● The initial recommendation by a doctor is to change one’s lifestyle, this can cure piles in grade I and II easily and effectively.
● A change in diet can also help easy bowel movement.
● Losing body weight may help reduce the incidence of piles.
● Regular exercise may lead to passing of the stools easily.
● Doctors may prescribe some laxatives that will help pass the stool easily without extra force.
● If it does not get treated with any medication, then surgery is sometimes the only option.
No surgery is required for Grade I. For Grade II piles can be treated with LASER. Grade III and IV piles can be treated with Conventional methods like excision of haemorrhoides, LASER haemorrhoidopexy, DGHAL or Stapler Haemorrhoidopexy. Bleeding piles does require treatment because bleeding may cause anaemia and further complications which may sometimes be life threatening.
Fissure in Ano, also known as Anal Fissure, is basically a small longitudinal cut in skin that lines the opening of the anus. Fissures cause bleeding and severe pain in the bowel movements. These are very common in the general public, but often confused with other pain. A fissure can happen at any point in your lifetime and can have equal general distribution.
Types of Fissure in Ano:
● Acute Fissure: Fissure in Ano less than 6 weeks of duration is known as Acute Fissure.
● Chronic Fissure: Anal Fissure with more than 6 weeks of duration is known as Chronic Fissure.
● Anal fissures are basically caused by stretching of the anal muscles beyond its capability.
● In adults, it is caused by the passing of large stools, constipation or by prolonged diarrhea. ● In older adults it is caused by the less flow of blood to that area.
● Anal sex can also be the cause of fissures.
Symptoms of Fissures in Ano:
● Tear in the skin around the anus
● Small lump of skin, or skin tag next to the tear
● Pain during bowel movement
● Stools with blood or pus
● Itching and burning in the anal area
Preventions During Fissures in Ano:
● One should drink enough water.
● One should have high fibre diet so that one does not suffer from constipation.
● Be careful and hygienic after anal defecation.
● In case of suspected fissure or any kind of pain, use a lubricating ointment.
● Sit in lukewarm water
Treatment for Fissures in Ano
Surgical treatments are not recommended, but there are some other measures that can be taken and are listed as follows:
● Some prescribed medication to lower the severity of pain.
● Nitroglycerin ointment may help heal the fissure.
● Having a rich fiber diet as a lifestyle change.
● Drink enough water as that helps in softening the stool.
● Sometimes Stool softeners may be required to soften the bowel movement.
When Anal Fissure does not heal with all of the above listed things, then a surgery may be required:
● Lower most part of the internal anal sphincter is divided laterally. With this acute fissure heals of its own. In chronic cases one may require to undergo fissurectomy.
● The surgery decreases the anal pain and spasm, allowing the fissure to heal.
● If a sentinel pile is present, it is removed to heal the fissure.
It is important to note that any kind of treatment requires 6-10 weeks to recover. However, the pain may disappear just after 2-4 days after the surgery. One must consult a doctor before going for any treatment. This surgery can also be performed with LASER,where there is less trauma and early recovery is posssible.
Anorectal disorders are common conditions like hemorrhoids, tears, fistulas, or abscesses that affect the anal region these are usually painful. Treatments range from recommendations for over-the-counter products to more invasive surgical procedures.