Perianal Crohn Disease (PCD)

Hello friends,

I am Dr. Dilip S Rajpal. I am a general and colorectal surgeon. Today I am going to discuss about perianal diseases. Most common symptoms of perianal diseases is usually painful defecation, bleeding PR and pus discharge from around the motion area. First of all before going anywhere I would like to highlight that not all bleeding PR are because of piles at the same time not all bleeding PR are because of cancer. Now the most important pathophysiology, any etiology of any disease related to motion area is constipation, straining at the time of motion and hard motion, three common disease what we usually see in this particular area one is fissure, one is piles and one is fistula, coming to fissure. Fissure, one of the commonest of the disease which is usually seen in very young age and common presentation is usually pain and also bleeding, basically it is a small crack in the motion area, any person who has hard motion, when he strains he finds a small cut in that particular area and because there is a cut, the muscles in that particular area they contract causing severe pain and because the muscles are contracting this wound or amal cut also fails to heal.

Now the treatment for this is medical treatment, very good appointments are available in today's date but the most important is taking care of constipation, because till the time of patient constipation is not cured or patient is having hard motion this small wound is never going to heal. The most important treatment would be laxatives and we practically stopped operating with these patients because what we do is bedside dilatation and once dilatation is done the patient is immediately pain-free and he is better applying ointments and taking medical treatment, otherwise if patient has recurrent diseases than we offer surgical treatment in the form of internal sphincterotomy. Coming to next disease called piles, now pilles is one of the most common diagnoses which patient assumes that each and every bleeding because of piles, now piles is nothing but it's mucosal prolapse so any person who strains at the time of motion some part of the anal mucosa that comes out and that is called piles, depending on the severity how much it comes out, how much its prolapses, severity are there. Now if it prolapses inside inside then something like pops then it will be a grade I or grade II, if it comes out of the motion area the patient complaint that he can feel something, but it comes and goes inside then it's usually grade III and if something comes out, but does not go inside it's usually grade IV.

As I already said the main reason is straining at the time of motion, hard motion so till the time all these things are not taken care of patient is bound to have this disease and it is never going to get cured. Treatment wise, in today’s world treatment is medical treatment in the form of laxatives, sitting in warm water because once you sit in warm water there is soothing effect, patient is better compliant, pain reduces and also the bleeding also reduces. Surgically we usually offer MIPS that is minimally invasive procedure for piles, which is done with the PPH03 stapler, with the help of the staplers complete surgery is done about the motion area, so it is definitely a pain-free surgery. Today we also do suture rectopexy, many times this staplers are quite expensive when this type of patient can not afford then we offer them suture rectopexy, surgery done completely above the motion area so hence it is painless surgery.

Other treatment options like laser treatment option nowadays is coming up in a very big way that can also be offered. All these and whatever form of treatment is offered is just to decrease the morbidity of the surgery, for recurrence patient has to take care of this, What I always tell all my patient is irrespective whether they get operated or not, whether they take Ayurvedic, homeopathic or allopathic you have to take care of your motions that till the time patients doesn't take dietary advice he is bound to have recurrence and third form of disease is fistula. Fistula is a small tunnel is formed within the motion area and outside skin which keeps on discharging pus so typical this pus discharges every 3 weekly, patient will have some pus discharge and because there is a pus discharge patient have lot of pain and he will have inflammation, he may have fever also very rarely but we need to operate that pus also, so for fistula treatment is 100% surgery.

So for all these perianal diseases the most important reason is constipation till the time patient does not take care of his diet, because these all are lifestyle diseases, diet in the form of patient should drink a lot of liquids, liquids like any form water, coconut water, Dal, soup, juice whatever you want you have fruits, vegetables, salad, all these leafy vegetables. All these leafy vegetables and salads are fibre and the more fibre you take more it will absorb the water and once it absorbs the water the motion become more and more softer this problem will decrease on its own. The non-vegetarian food, extra spicy food, cheese, chocolate should be reduced as much as possible because they all alludes more and more constipation and also patient should not strain at the time of motion, patient should pass motion as and when he feels right, don't try to control and patient motions should always be soft, if we follow this advice then patient’s motion will be soft, any motion related problem will never ever recur in his life. For any such more videos you should definitely go to lybrate page.

Thank you