Diseases of the rectum
For complaints in the area of the rectum/anus such as itching, pain, bleeding or problems with bowel movements, we can make a diagnosis and perform a treatment usually by undergoing a brief and usually painless examination (endoscopy of the rectum or proctoscopy). For this examination, no preparation is required. In some cases however, the prior implementation of a small enema for cleaning the rectum may be recommended.
The following diseases can be treated at our practice:
Blood vessels at the anus are present and act as a fine "seal" of the rectum to prevent liquid incontinence. Among some hereditary conditions, constipation and other risk factors can lead to the extension of these blood vessels. There are four stages defining this condition, which is based on the haemorrhoid size and location. Treatment can be determined, once the haemorrhoid stage has been established. Note that the most important therapy for all stages is adequate stool regulation with the use of laxatives, if required. Furthermore, we can streamline the mucosa in the rectum with the use of ligatures (i.e. a thread or string without a needle used to tie blood vessels and other tissues together). For large haemorrhoids, surgical treatment must be discussed. When unclear results arise, a complete colonoscopy is often recommended. A protrusion of the intestinal mucosa is known as a prolapse (rectal prolapse or anal prolapse) and usually requires surgical therapy.
Anal vein thrombosis
This involves a sudden painful swelling of the anus due to the formation of a blood clot in a blood vessel at the anus (thrombosis). When severe pain arises, we can perform a small incision and remove the clot during local anesthesia; this usually leads to immediate pain relief.
Anal marisca are small masses located at the anus. The marisca is generally soft and painless on palpation. Anal marisca present no health hazard and usually cause no pain, it is not necessary to treat them. However, they can be removed in a small procedure under local anesthesia when they interfere with daily hygiene.
This is usually a very painful crack in the skin of the anus. In conjunction with good stool regulation, we often recommend a longer term ointment therapy. In some cases, surgical treatment should be discussed. Pruritus ani or anusitis (itching): in addition to infection with parasites as an example, other causes such as incorrect hygiene (the use of wipes), haemorrhoids and so on can come into question. If the cause can be detected, therapy is usually possible. However, some cases have an undeterminable cause (idiopathic pruritus ani).
In the specific case of Crohn’s disease, small passages can form in the region of the anus that secrete liquid/pus and can be painful. Imaging techniques such as endoscopic ultrasonography are used to determine this condition in more detail. Therapy is usually a combination of medication and surgery (e.g. seton insertion)
Pus in the area of the rectum can be very painful. This can occur in the presence of fistulas often in association with chronic inflammatory bowel disease. An abscess must always be treated promptly, and referral to a surgeon is most often necessary.
Condylomata acuminata (genital warts)
Genital warts are caused by an infection with HPV (human papilloma virus). This disease is contagious and should involve treatment of both the patient and partner. For internal genital warts, we use laser or cryotherapy. In some cases, surgical treatment is recommended.
Inflammation in the rectum may occur in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis) or during an infection. Usually a complete colonoscopy is required. Treatment depends on the cause and diagnosis.
Cancer in the rectal area usually occurs in conjunction with, for example, HIV or HPV infections. Even women with cervical dysplasia (changes in the cervix) have an increased risk for these tumours. Small tumours can be surgically removed and for large tumours, chemoradiotherapy is recommended.
The involuntary loss of liquid or solid stool can be a very large psychosocial burden (shame, avoidance of social contact, etc.). We determine the possible causes (usually with colonoscopy, ultrasound of the rectum among others) and organise possible forms of therapy (pelvic floor exercises, surgery, sacral nerve stimulation), as required. Nowadays, faecal incontinence can almost always be treated!
We work closely with www.proctomed.ch. For regularly updated gastroenterological guidelines, visit the platform, www.swissgastroenterology.ch, initiated and realised by our physicians.