Illnesses & treatments

 

The proctological diseases are numerous and variable. They can be divided into several groups: trophic and vascular pathology, tumoral pathology, dermato-venereologic (include STDs) pathology, anal and extra-anal suppurations.

 

The following list is not exhaustive. I advise you to keep in touch with the site which, while developping itself, will give a quite complete description of the different lesions.

 

Right now, you can however visualise the photo(s) linked to each pathology.

 

The trophic & vascular pathology:

- Fissures of the anus

- Hemorrhoidal illness

 

The tumoral pathology:

- Rect-sigmoidian cancers and polyps

- Cancers of the anus

 

The dermato-venereologic pathology:

- Anal pruritus

- STDs (sexualy transmitted diseases)

- Proctology and AIDS

 

Anal suppurations:

- Abceses and fistulas of the anus

- Extra- anal suppurations

 

Constipation, incontinence, perineum descending:

- Medical or chirurgical treatments: which ones to choose

- The importance of the ano-rectal and/or perineal functional explorations

 

Nowadays, well-systematized treatments represent considerable advances which will gradually allow to treat all of these diseases efficiently

 

  • FOCUS ON ONE PROBLEM : ANORECTAL NEURALGIA

Anorectal neuralgia constitutes a difficult and complex chapter in proctology. Pain occurs at any time of the day or night, divorced from any anal lesion.

 

There are three types of neuralgia :

- The syndrome of proctalgia fugax consists of very severe paroxyms of pain, often occurring during the night, wich en within a gex minutes, either spontaneously or sometimes with the assitance of a spasmolytic suppository or of a tablet of glyceryl trinitrate, given on the assumption that there is spasm of the levator ani and ischaemia producing real rectal angina. In any event there are psychosomatic components often in all these patients.

 

- Anorectal neuralgia. This is more typical and often occurs in women. There is very commonly a genital history (hysterectomy, retroversion of the uterus, endometriosis of the rectovaginal junction) in the years before the onset of the syndrome. Here too there is a psychosomatic context in many of the patients.

 

  • Coccygodynia with rectal involvement produces the same clinical type of neuralgia, especially when the patient is seated for a long time. The diagnosis is

 

simple : movement of coccyx and sacrum exacerbates the pain.

 

Treatment os spinal lesions, especially by manipulation, which relieves muscle spasm, fairly frequently brings about good relief.

These three states have in common :

- a background of colitis

- a component of spinal osteoarthritis

-a genital or pelvic involvement

- and especially, a specific emotional imbalance which leads possibly to pruritus ani.


 

TREATMENT

 

By the general practitioner himself

 

1 - Drug treatment

Purely medical treatment is fully justified for uncomplicated haemorrhoids, where fissure and thrombosis are absent, provided the attacks are intermittent and infrequent as well as rapidly controlled for long periods by this management.

 

Rectal administration :

Local decongestion by suppositories containing bismuth carbonate or subnitrate, colloidal silver, anti-inflammatories, anticoagulants, antipruritics.

 

Diet is important and constipation must be corrected by gentle laxatives (paraffin oil, mucilage) but irritant laxatives and all suppositories said to be effective for constipation must be avoided, as they often damage the anal mucosa. However, if haemorrhoids, despite such treatment, frequently give rise to a sensation of pressure or pruritus or rectal bleeding, or if they are prolapsed, these medical measures must be relegated to an auxiliary status ans injection or surgery must be performed.

The same applies to pruritus ani :

- When pruritus is transient and occurs for a few days each year : it is often sufficient to use : permanganate baths, antiseptic dye solutions, topical pastes, or steroids and antimycotics if necessary.

 

- In the event of recurrence it is especially important to treat the cause. Very superficial fissures (details given in the section on fissures-in-ano) can be treated by Bépanthène, in a course of 6 to 12, daily intravenous injections, together with applications of aqueous dyes and vitamin-containing ointments.

Simple thrombosed haemorrhoids can sometimes be relieved by applications of hyaluronidase or its derivatives (see the chapter on haemorroids).

Where drug treatment is insufficient, more active measures must be considered.