In spite of what is commonly thought, anal pathologies are not limited to hemorrhoids, although this is probably the first thing that comes to people’s minds. We must also include fistula and anal fissure among the most common problems. These are the three most frequent pathologies that I face as a proctologist, so much so that it is estimated that about 40% of the population has some kind of problem in the anus.
Hemorrhoids, stages and techniques
If we focus on hemorrhoids, we must clarify that not all of them are operated and that they are classified in four stages. The first stage is when hemorrhoids simply bleed. The second stage is when they prolapse, that is, when they come out when defecating and reposition themselves.
The third stage is when this repositioning must be done manually and in the fourth stage it is impossible to put the hemorrhoids back in place. Of these four stages, the third and fourth advanced stages are currently the most commonly operated on.
To remove hemorrhoids, the most commonly used technique is still the open Milligan-Morgan technique, with which excellent results are obtained and the hemorrhoids are removed forever. However, it is an operation that has a painful postoperative period that must be treated with painkillers. Curiously, the wounds do not cauterize until 20 days, but after ten days the pain is gone, probably because there is a relaxation of the area.
There are also other processes such as rubber band ligation, which is performed on an outpatient basis and consists of necrotizing the hemorrhoid so that it falls off after three or four days, or the use of sclerosing substances.
The confusion with anal fissure
Many people go to the proctologist’s office with anal pain thinking they have hemorrhoids when, contrary to widespread belief, hemorrhoids do not really hurt. If there is pain, the problem is usually an anal fissure, which is nothing more than an exaggerated contraction of the internal sphincter that ends up causing a lack of blood supply, which in turn causes an ulcer.
The most frequent causes of anal fissure are stress, anguish and also chronic constipation. This anal fissure can be solved with a sphincterotomy, which consists of an incision that helps to relax the sphincter, thus solving the problem forever.