19 Sep 2018

A private medical practitioner, Dr Joseph Raleero had stressed the importance of education on anal disorders to avoid complications.

While the part affected was private in nature, the need to understand disorders affecting it can never be overemphasised, he told BOPA in an interview recently.

Dr Raleero, who is based in Gaborone said there were many disorders that occur on the anal part, but because of lack of knowledge on such disorders, some victims often dismissed them as ‘nothing’, that whatever it was, it would simply go away.

He said if Batswana could differentiate between different anal disorders, they would be in a better position to explain them during medical consultations.

The disorders are anal fissure, anal abscess, anal fistula and thrombosed external hermorrhoid, he explained.

“We have what is called the anal fissure. Also called an anorectal fissure.

It is a linear split or tears in the lining of the lower anal canal,” said Dr Raleero.

He clarified that most anal fissures happen when a large, hard stool overstretches the anal opening and tears the delicate anoderm.
Less often, Dr Raleero said anal fissures develop because of prolonged diarrhoea, inflammatory bowel disease or sexually transmitted diseases involving the anorectal area.
“Acute or short term anal fissures are usually superficial and shallow, but chronic or long term anal fissures may extend deeper through the anoderm to expose the surface of underlying muscle,” Dr Raleero elaborated.

Another disease that was common, he explained, was the anal abscess, which he described as a swollen, painful collection of pus near the anus.
Most anal abscesses, he said, were not related to other health problems and arose spontaneously, for reasons that are unclear.

“They originate in a tiny anal gland, which enlarges to create a site of infection under the skin,” explained Dr Raleero.

Most anal abscesses are located near the opening of the anus, but can rarely occur deeper or higher in the anal canal, closer to the lower colon or pelvic organs, he said.

Another one of the disorder is anal fistula. This, he described as an abnormal narrow tunnel-like passageway, which is the remnant of an old anal abscess after it has drained.
It connects the mid portion of the anal canal to the surface of the skin.

For treatment, Dr Raleero stated that a doctor must diagnose the disorders.

Once the diagnosis is made, treatment may or may not involve surgery, depending on the specific disorder.
If surgery is necessary, the doctor would use whatever type of anesthesia appropriate to help prevent the patient from feeling pain in this sensitive area.

For anal fissure, he stated that the doctor may recommend that one follows the suggestions for relieving constipation.
“They may instruct a patient to apply a medicated ointment to the fissure, and to soak the anal area in warm water for 10 to 15 minutes several times a day in what is called a sitz bath.

For chronic fissures, surgery can correct the problem in more than 90 per cent of the bcases, he said.
Anal abscess, he noted, must be opened or lanced by a doctor to drain the pus through a procedure called incision and drainage.

“This can usually be done as an outpatient procedure, especially if one is young and generally healthy, and their abscess is close to the anal opening,” the doctor said.

He further explained that anal fistula often requires surgery to unroof the fistula track or the fistulotomy, which is the most effective therapy.

In this case he narrated that the doctor opens the infected canal and scrapes away any remnants of the old anal abscess.

The wound, he said, would be left open to heal from the bottom up. If the fistula is associated with Crohn’s disease, treatment is directed toward the Crohn’s disease with anti-inflammatory medications combined with an antibiotic, he said. Ends