Proctology

HAEMORRHOIDAL DISEASE / COMMONLY KNOWN AS PILES

We encounter haemorrhoids (hemorrhoids), commonly also known as piles, when referring to the most wide-spread proctological condition. Haemorrhoids are a regular part of the rectal structure and contribute, for instance, to maintaining continence. A sedentary lifestyle and unhealthy diet are responsible for haemorrhoids being classified as modern civilization diseases. We talk about the disease only when the vascular plexus unusually enlarges, begins to protrude outside the anal canal, and causes difficulties.

MANIFESTATIONS OF THE HAEMORRHOIDAL DISEASE

Difficult bowel movements accompanied by bleeding, blood on the stool or toilet paper, palpable nodules at the end of the rectum, unpleasant sensations in this area, pain, itching, burning, and in advanced stages, the mucous membrane may prolapse. Severity is distinguished on a scale from 1 to 4. The higher the severity, the more painful it becomes, the risk of infection and complications increases, and the treatment and healing process is prolonged.

TREATMENT OF HAEMORRHOIDAL DISEASE WITH LASER

Laser represents a suitable and minimally invasive solution for treating the disease at stages 2-3 (sometimes even 4). The procedure is performed in a gynaecological position on a specially adapted chair using local anaesthesia, usually combined with analgesic sedation via Entonox gas inhalation.

HOW DOES THE LASER PROCEDURE WORK?

1. First, we assess the current condition with an anoscope.
2. Using an ultrasound probe, we identify where exactly the supplying artery is in each haemorrhoid.
3. A special fiber is inserted under the mucous membrane to the artery, delivering a laser beam. This beam's purpose is to close the artery. Inserting the fiber creates a single "cut" - right at the anal edge; everything else happens under the mucous membrane using laser energy. A hemorrhoid is usually nourished by about three arteries, so the entire procedure typically involves three small cuts.
4. Another laser beam is directed into the hemorrhoidal node to initiate its reduction.
5. Each node is treated in this fashion.
6. A cooling roller is applied to the rectum.
7. 85% of clients use analgesics for a maximum of 1–2 days after the procedure.

PILONIDAL SINUS / PILONIDAL CYST

This condition is an inflammatory abscess or cyst located in the area of the coccyx and sacrum. The most common cause is ingrown hairs penetrating the subcutaneous tissue. During inflammation, a cavity filled with hair and pus forms, which the body attempts to expel to the surface through small tunnels (fistulas). It might seem that if the pus is drained, the sinus could heal on its own. However, since the pus does not remove the cause, i.e., the hair, spontaneous healing cannot occur.

HOW DOES A PILONIDAL SINUS MANIFEST?

Redness, swelling, tenderness, sometimes accompanied by fever or chills. If the condition is chronic, there is a feeling of pressure, pus discharge, and recurrent inflammations.

TREATMENT OF PILONIDAL CYST WITH LASER

The procedure is performed in the gynaecological position on a specially adapted chair using local anaesthesia, usually in combination with analgesic sedation using Entonox gas inhalation.

For comparison, let's outline the course of treatment using surgical techniques. This involves initially draining the cyst and, after the inflammation subsides, completely excising it. This creates a large wound in the stressed area of the rectum, which is prone to infections and bleeding. Thus, the recovery is complicated and typically lasts several months.

HOW DOES THE LASER PROCEDURE WORK?

1. First, the edges of the fistula are trimmed, and the contents of the cyst and the inflamed lining are removed.
2. Using a laser, the cyst is "welded" and closed from the inside.
3. A small section at the opening is left open for any remaining tissue debris and fluids to escape. Once expelled, this section will gradually close on its own.
4. Only the affected tissue is treated, leaving everything around it intact.
5. The procedure is practically painless. 84% of patients do not require any painkillers, and some only need paracetamol.
6. By the 6th to 8th week, the cyst is completely closed.
7. The overall recovery period is, however, significantly shorter, averaging only around 6 days.

ANAL / PERIANAL / PERIRECTAL FISTULAS

Anal fistulas are the result of the inflammation of a sebaceous gland located under the mucous membrane of the anal canal where it also opens. If such a gland becomes inflamed, it swells and forms an abscess. This abscess either drains itself into the muscles and subcutaneous tissue or needs to be removed.

HOW DO FISTULAS MANIFEST?

Swelling, tenderness, oozing, constant secretion of pus, stool passing through the external opening, a feeling of moisture around the anus, soiling of clothing with pus and stool, odor, and skin irritation.

TREATMENT OF FISTULAS WITH LASER

The greatest advantage of laser treatment is the minimal risk of sphincter injury. The procedure is performed in the gynaecological position on a specially adapted chair. Local anaesthesia is used in combination with analgesic sedation via Entonox gas inhalation. Sometimes, draining of the fistula for about 4 weeks precedes the procedure. This method is especially suitable for treating complex fistulas.

Traditional treatment without laser assistance is very invasive and complicated. It involves at least two procedures in general anaesthesia: the first for a thorough examination of the rectum and treatment strategy planning, and the second for the actual surgery. Often, it is impossible to completely remove the fistula without risking sphincter injury and subsequent incontinence. Therefore, with surgical treatment, the disease often recurs.

HOW DOES THE LASER PROCEDURE LOOK LIKE?

1. First, we assess the current state with an anoscope.
2. Using a special tool, we clean the fistula.
3. In some cases, we close the internal opening of the fistula by shifting the mucosa or using absorbable stitches.
4. A laser fiber is threaded through the entire fistula – from the external opening to the internal one. This fiber is then withdrawn while simultaneously emitting laser energy, leaving the fistula "welded" and closed behind it.
5. A few millimeters of the fistula's opening are left open to allow any remaining tissue debris and fluids to escape. Once this material is expelled, the opening gradually closes and scars over.
6. Complete closure takes about 6–10 weeks.
7. The procedure is practically painless, with recovery taking approximately 6 days.

ANAL FISSURE

This is a painful injury in the anal area, specifically a tear in the anodermal transition. It can occur due to hard stools, persistent diarrhea, anal intercourse, childbirth, etc. The cause is often excessive tension in the internal sphincter. Combined with hard stools or persistent diarrhea, this creates conditions for a tear. Fissures are classified as acute and chronic, with chronic fissures resulting from neglecting the treatment of acute fissures. Insufficient or no treatment leads to gradual scarring, repeated tearing of the fissure, and long-term complications.

HOW DO FISSURES MANIFEST?

Pain, bleeding before and after bowel movements, itching – often at night.

TREATMENT OF ANAL FISSURES WITH BOTULINUM TOXIN

Treatment includes adjusting bowel habits, hygiene, and diet to regulate stool consistency. Given the excessive tension of the sphincter during the formation and maintenance of fissures, botulinum toxin presents a minimally invasive and excellent solution. Botulinum toxin plays a significant role in a very small amount. Just as it is used to smooth wrinkles or reduce sweating, its neurotoxic properties are utilized in this procedure. The substance can block neuromuscular impulses, preventing muscle contraction. In treating fissures, botulinum toxin is microinjected into the fissure area, temporarily disabling the internal sphincter. By relaxing the sphincter, the overall tension is reduced, allowing the fissure to shrink and heal more quickly and effectively with conservative treatments (i.e., ointments and suppositories).

HOW DOES BOTULINUM TOXIN TREATMENT WORK?

1. First, we assess the current state with an anoscope.
2. Using a thin microinjection, we administer a precisely defined number of botulinum toxin units to several areas of the internal sphincter. The sphincter is not disabled but the tension is appropriately reduced, creating conditions for the fissure to heal successfully.
3. The procedure is painless; in special cases, an anesthetic cream is used.
4. After about 4 weeks, the fissure is sealed and healed.

Condylomata / viral warts

Viral warts on the skin around the anus and in the external genital area are relatively common viral infectious disease of the skin and mucous membranes. Due to the way they are transmitted, they are classified as sexually transmitted disease. They are caused by members of the human papillomavirus (HPV) group, some serotypes of which, unfortunately, have cancer-causing potential. This is where the great danger of condylomata lies, which is why early treatment is so important along with prevention.

How do condylomata manifest themselves?

Condylomata take the form of white to reddish warts on the skin and mucous membranes in the genital area and anus. The warts do not hurt, but they may itch.  

Laser treatment of condylomata

Condylomata are removed on an ambulant basis with a laser under local anaesthesia, possibly supplemented by general analgosedation with inhalation of Entonox gas. The elimination of warts as active centres of infection prevents their further spread and possible progression to cancer. The laser is very precise and therefore it is possible to target even relatively small deposits without affecting the surrounding healthy tissue. 

Local laser treatment needs to be combined with systemic drug treatment, which is aimed at strengthening the immune system in an attempt to increase its effectiveness in eradicating papillomaviruses.