Thursday, June 26, 2014

Non-Surgical Solutions for Anorectal Disorders

By: Rajat N. Parikh, MD with Birmingham Gastroenterology Associates

Anorectal disorders consist of a vast array of diagnoses and are common; however, patients affected remain undiagnosed and undertreated. Most common in these group of disorders are rectal bleeding from internal hemorrhoids, anal pain and constipation from anal fissures, and fecal incontinence.

Internal hemorrhoid banding for rectal bleeding is a highly effective (99.1%), minimally invasive procedure that is performed in our office in less than a minute. We make recommendations to reduce the chance of recurrence later (currently 5% in 2 years). If there are multiple hemorrhoids, we treat them one at a time in separate visits. During the brief and painless procedure, the physician places a small rubber band around the tissue just above the internal hemorrhoid where there are few pain-sensitive nerve endings. The procedure works by cutting off the blood supply to the hemorrhoid. This causes the hemorrhoid to shrink and fall off- typically within a day or so. Patients probably won’t even notice when this happens or be able to spot the rubber band in the toilet. Once the hemorrhoid is gone, the wound usually heals within one to five days. The procedure is extremely well-tolerated but few patients may experience a feeling of fullness or a dull ache in the rectum during the first 24 hours. This can typically be relieved with an over-the-counter pain medication.

The loss of bowel control, also called accidental bowel leakage or fecal incontinence, is a common problem many of our patients face. Unfortunately, many are not getting diagnosed and treated as they might feel embarrassed to talk about it – the leakage, staining, and odors. Sometimes it is a lack of information on available therapies. There is a non-surgical approach to treat this condition that we offer our patients. Solesta is a quick, in-office injection therapy that can give improved control over accidental bowel leakage by bulking up the tissue in the anal canal. There is no lengthy recuperation and patients can resume their daily activities very quickly. Our experience at BGA has been positive thus far with minimal risk of side effects such as mild pain or bleeding. Patients are evaluated thoroughly before Solesta injection therapy is performed with rectal endoscopic ultrasound and anal manometry, if indicated, to make sure they are a good candidate.

Anal pain is almost always passed off as due to external hemorrhoids, and patients will try all forms of over the counter remedies without benefit. If pain is usually sharp or razor-like with bowel movements and the patient has feelings of anal spasm, it is almost certainly due to an anal fissure. There are various compounded ointments with smooth muscle relaxers or nitroglycerin preparations which can be used to allow the anal sphincters to relax and allow improved blood flow to the area of the fissure to allow for better healing. In addition, once or twice daily sitz baths are also helpful in the healing process. Commonly, patients have relief but symptoms can recur if it is due to a chronic scarred anal fissure. If this is the case, we can inject BOTOX bilaterally into the anal sphincters to allow for more efficacious healing and long-term benefit with minimal side effects. Chronic fissures are sometimes seen in Crohns disease and should be ruled out. Surgery is effective but is a last resort due to difficulty with recovery and possible complications with incontinence.

In summary, there are effective therapies available to patients suffering from anorectal disorders whether it is bleeding, pain or fecal incontinence.

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