Despite what is commonly thought, anal pathologies are not reduced to hemorrhoids, although it is probably the first thing that comes to mind. 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 around 40% of the population has some type of problem in the year.
Hemorrhoids, stadiums and techniques
If we focus on hemorrhoids, we must clarify that not all are operated and that they are classified into four stages. The first stage is one in which hemorrhoids simply bleed. The second degree is when they already prolapse, that is, when they go out to defecate and reposition themselves. The third stage is when that relocation must be done manually and in the fourth it is impossible to place the hemorrhoids back in their place. Of these four stadiums, the advanced third and fourth are currently operating.
To eliminate hemorrhoids, the most used technique continues to be the Milligan-Morgan open technique , with which excellent results are obtained and hemorrhoids are eliminated forever.. However, it is an intervention that has a painful postoperative period that must be treated with painkillers. Interestingly, the wounds do not cauterize until 20 days but after ten days the pain is over, probably because there is a relaxation of the area.
There are also other processes such as ligation with elastic bands , which is done on an outpatient basis and consists of necrotizing the hemorrhoid so that it falls after three or four days, or the use of sclerosing substances.
The confusion with the anal fissure
Many people come to the proctologist's office with anal pain thinking that they have hemorrhoids when, contrary to the widespread belief, hemorrhoids do not really hurt. If there is pain is that 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 flow that in turn produces 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 with which the problem is solved forever.