Proctology: Anal examination, coultation, type of surgery for hemorrhoid and anal fistula, and our surgical cases

Consultation takes place in the examination room.

Posture should be oriented mainly to the left down, you put on the special pants so that  buttocks are not exposed much. Before anosocope , gently palpate it to see how much pain and tension you have. You also have a rectal examination, and an important examination to see if there is bleeding,  or tumor in the rectum. Then anoscope would be done when the doctor explains it by looking at the monitor of  the anoscope image if you like.

We also treat anal fistulas, anal fissures, thrombosed external hemorrhoids, proctal abscess and pruritus ani, but the diagnosis may be different from your own judgment, so an appropriate medical examination is necessary first.  The doctor uses different  type of anoscope (considering pain, or it depneds on what he wants to see  etc.), and for examination of anal fistula, palpation is important.

Information from you is important as the examination like bleed  or pain as toiolet, pain at rest and worse something like these.

Addtional ultrasound and MRI will be used for more detail. For emergency, most of proctal abscess and  some of thrombosed external hemorrhoids need emergency surgery.  Colonoscopy is vitaly imoportant for those who have bleed on the stool, and discomfort as bowel movement , and changing the toilet habit because possibility of large colon disesase like colon cancer , inflammatory bowel disease, and polyps some of which are prestage of colon cancer.

In particular, the symptoms of prolapse of hemorrhoids may not be recognized when you have  examination here.  That is stressfull for you.  But it appears at home, or only after delivery. In that case, only images by SELFY would serve as important information.  (In some cases, it has a great influence).

( PS: One of proctologists: Dr. Masatoshi Sasaguchi, Seishinkai Yoshida Hospital in Niigata tells us  this importance and were also the article in local newspapers)

Surgery of hemorrhoids

Injection therapy(Sclerotherapy): ALTA ( zione )

In Japan, the treatment has started to be taken up in the media from around 2013, but since 2005, ALTA ( aluminum hydrate tannic acid ) 　: Zione ® 　is covered by insurance, and nearly 600,000 people have already received treatment. Also, data such as side effects are maintained and considered safe. Compared with the conventional ligation and resection, which is a surgical operation, it is less burdensome on the body and there is almost no pain or bleeding during defecation after surgery. You can also rest assured that there will be no sequelae due to scarring associated with the incision. No need for hospitalization, local anesthesia is possible (younger people recommend sacral epidural anesthesia in consideration of intraoperative tension), but you can return to work two days after surgery.

Combined use of ALTA and resection

Since ALTA(Zione） is not generally indicated for the hemorrhoids on the outer side, conventional ligation and excision are used together, but there are many voices with strong postoperative pain. Therefore, we have succeeded in reducing the pain during defecation after surgery by performing a small incision on the external hemorrhoid to remove hemorrhoid.

Ligation and Excision: LE , world standard

Although it is gold standard   in the world, it is characterized by its high creativeness, although the pain during defecation after surgery is not light and there is a considerable risk of bleeding. The average time to go to work is around 5-8 days.
Separation and ligation started in November 2018. Since it cures without cutting, it reduces pain and reduces the risk of bleeding compared to excision.

Anal fistula

Yamate medical center and other medical facilities are still the core of Japanese proctology, but we still have surgery for anal function. As far as possible, we are performing surgery that emphasizes functionality as well, and in 2019, there were almost no recurrence cases that preserved the internal sphincter. In 2019, the number of surgeries increased by 8% compared to the previous year, and since 2017, approximately 50% of the major anal surgery cases at our hospital are anal fistulas. Generally, the rate of surgery for anal fistula is 10-20% of anal surgery.

Anal fissure

Some people may be surprised by bleeding or pain during defecation, but those who can come up with symptoms soon tend to have acute fissures, and the pain is relatively strong. , I think that there are many people who have a good course if they correct constipation, which causes reassurance, and highly simulative meals if they are corrected by guidance.

However, it can be difficult to treat if you have anal stenosis, if the ointment treatment does not work, or if you have had symptoms for several years but have been left as they are. In such cases, it is subject to surgery. Since surgery is caused by bowel habits such as constipation and diarrhea, recurrence may occur even after surgery, and the surgery may become complicated after considerable stenosis has progressed, so early consultation and treatment are recommended. .. After the actual surgery, it is not possible to hide the appearance of having escaped from pain after returning to comfortable bowel movements for the first time in a while.

IT Anal medical examination

We will utilize the digital anoscope even during surgery, provide images if desired, and proceed with surgery after consent.

For example, depending on the medical condition, there are many cases in which the selection of the surgical procedure (eg, injection or excision) is provided at important points and the image information is provided at the important points, and after consultation, the decision is made.

Pruritus ani

At the same time as the medical examination, fungi and bacteria are inspected, and appropriate treatment such as ointment is selected in consideration of the patient’s situation and the patient is followed up. During that time, changes in skin findings are important, so record an image and observe the changes. There are many unexplained causes, and it is not possible to get a clear solution with a single medical examination. Based on the above, we will proceed with medical treatment while talking to each other and proceed to the solution.