Anorectal conditions: Causes, treatment and prevention

Anorectal conditions can be differentiated into benign and malignant conditions. Thankfully, most of the time, the symptoms a patient presents point to benign anorectal conditions.

In this article, Mr Gordon Neil Buchanan, leading colorectal surgeon, explains what the different anorectal conditions are, how they are caused and how they can be treated, among other important points.

Common malignant anorectal conditions include:

• rectal cancer
• anal cancer
• pre-cancerous conditions of the anorectum (e.g. anal polyps)

Fortunately, these are less common than benign anorectal conditions. Anal cancer, which is very rare, is associated with the human papillomavirus (HPV) in most cases. Rectal cancer is usually caused by a pre-existing polyp which then develops into a cancer over a long period of time. Anal cancer can be prevented largely by immunisation with the HPV vaccination, particularly in high risk groups. Pre-cancerous anal polyps can be removed endoscopically for testing. Screening programs will also lower the chances of anal and rectal cancer.

Common benign anorectal conditions include:

• fissure-in-ano (anal fissure)
• fistula-in-ano (anal fistula)
• pilonidal sinus disease
• anal skin tags
• haemorrhoids

Fissure-in-ano (anal fissure) is often associated with straining and constipation which can result in a tear in the anal canal. Anal fissures can usually be treated with creams administered on a daily basis. However, some anal fissures will require surgery.

Fistula-in-ano (anal fistula) is usually associated with abscesses, and these occur in what is known as the inter-sphincteric space. In most cases these can then travel across the sphincter muscle, causing fistula-in-ano. Anal fistulae will nearly always require surgery to heal properly. A fistulotomy involves the fistula being cut open lengthways, having the area cleaned, leaving a clean, flat scar behind once healed. Sometimes, a surgical procedure using a skin flap to close the wound can be used. The choice of surgery depends on the balance of maintaining the sphincter function versus eradicating the fistula.

Pilonidal sinus disease is usually caused by hairs that decide to grow inwards instead of growing outwards. For some reason, these hairs secrete fluid inwards and create chronic infections. This condition is difficult to prevent, but keeping the area hair-free can help to improve cleanliness. Hence, surgery is usually required to remove the pilonidal tissue and a flap of skin is may be used to close the wound.

Anal skin tags do not have a definitive cause, but for some reason, extra tissue just seems to grow around the anal verge causing anal skin tags. Anal skin tags can be removed very easily with a simple surgical procedure. They can be removed either under general or local anaesthetic depending on their size and position, and done as a day case procedure. Surgery usually involves cauterising the base of the skin tag to prevent further problems like bleeding. This will often leave a wound that needs to heal. Even though this is a small operation, it can be uncomfortable for the patient for at least 1-2 weeks and can take a further month to heal after that.

Haemorrhoids are enlargements of normal anal cushions at the top of the anal canal, that when enlarged can produce symptoms that require treatment. Symptoms include rectal bleeding and in more advanced cases, prolapse. Treating haemorrhoids can either involve lifestyle changes, over-the-counter remedies, outpatient procedures or surgery. Treatment will depend on the severity of the haemorrhoids and the symptoms presented.

In general, there are not many preventative strategies for these benign anorectal conditions, but simple lifestyle measures such as eating a high fibre diet can help to minimise the chances.

If you are interested in finding out more about these anorectal conditions, do not hesitate to make an appointment with a specialist such as Mr Gordon Neil Buchanan to receive expert assessment and advice.