Proctology

Haemorrhoids are vascular cushions that sit annularly on the rectum and seal it off from the outside. For various reasons, they can swell and emerge from the anus at an advanced stage.

Depending on the degree of severity, different treatment options are possible. In early stages we recommend conservative therapy with decongestant and analgesic ointments in combination with painkillers and stool-regulating measures. Haemorrhoids in an advanced stage (grade III and IV) should, however, be treated surgically.

We will discuss in detail with you which operative procedure will be used. In addition to the classic surgical removal (haemorrhoidectomy), minimally invasive techniques such as "sclerotherapy" are used, which leave no external wounds.

Anal venous thromboses are harmless blood clots in a small vein in the anus, which can lead to a blue-black swelling and cause severe pain. They usually occur after heavy pressing or diarrhoea and are mostly treatable with decongestant and analgesic measures. If the pain is very severe or has not subsided, they can be removed.

Anal fissures are very painful tears in the anus. They are usually caused by hard stool and excessive pressing. In addition to stool regulation, an ointment therapy with analgesic and muscle relaxing effects over several weeks is necessary. In most cases anal fissures heal under conservative therapy. Surgical therapy options are available for chronic cases.

A painful knot of pus (abscess) can develop when germs from the stool get into a crack (fissure) and lead to an inflammation of the anal gland. In the case of a chronic course, ducts (fistulas) lined with inflammatory tissue form, which can run in different directions and depths.

Abscesses have to be opened operatively without delay. Depending on the type of fistula, fistulas should also be treated surgically. In the case of a superficial course, fistulas heal without affecting the faecal continence. However, if the fistula tract perforates the sphincter, the effects on sphincter function must be considered when deciding on therapy. In such a case, we use surgical procedures that are gentle on the sphincter muscle.

Coccyx fistulas are chronic inflammations of the gluteal fold. All parts of the coccyx fistula as well as any abscesses and fistula ducts that may have formed should be surgically removed. In the case of acute inflammation, the wound is left open, whereas in the case of chronic inflammation, the wound should be closed, if necessary with a plastic covering.

Genital warts are virally caused warts that should be surgically removed to prevent further spread or even degeneration. We remove genital warts using a wire loop heated by electric current (electrocautery) or a laser.

In a rectal prolapse, the rectum protrudes outwards. There are three different degrees of prolapse. Depending on the degree of severity, the spectrum of treatment ranges from surgery through the anus to laparoscopy with partial removal, lifting and fixation of the rectum (laparoscopic resection rectopexy).

Faecal incontinence is the inability to actively control or restrain defecation. It is divided into three degrees.

The causes of faecal incontinence are manifold. A distinction is made between muscular incontinence, where the cause is direct damage to the sphincter muscle, and neurogen-sensory incontinence, where the sphincter muscle is intact. In this case, there is an indirect cause such as a pelvic floor prolapse or a rectal prolapse. Incontinence can also occur as a result of an operation or tumour disease.

As a rule, we first carry out a conservative therapy with the aim of regulating digestion and strengthening the pelvic floor muscles. Concomitant physiotherapy and nutritional advice are used. Regular self-exercises and a healthy diet usually help to get the problem under control.

The next step is the application of threshold current to strengthen the support structures of the pelvic floor. In most cases, we can achieve a significant improvement or even cure faecal incontinence with these therapies. In rare cases, surgical therapy is necessary.

Nowadays, sacral nerve stimulation (SNS) is an excellent procedure. In a small procedure, we place electrodes at the exit points of the nerves above the sacrum to regulate the rectum. A small pacemaker then regulates continence.