FAQs

Is cold or lukewarm water better for washing up after defecation?

Washing up with lukewarm or warm water is a preferable choice. Cold water causes spasms of the sphincters of the anus. These spasms deteriorate the haemorrhoids and the abscess.

What is the best treatment for anorectal fistulas?

Surgical treatment is always the best option for anorectal abscesses. The antibiotics can’t give a definitive treatment, so the abscess becomes more severe and more extensive. The only reason for prescribing them is when the abscess cannot be detected because of not having an anal ultrasound examination. If the abscess is not drained surgically, then it may cause septicaemia.

The pain gradually advances and swelling has also appeared . Perhaps there is fever. What is really happening?

It looks like an anorectal fistula is appeared. It has to be opened and then we need to remove the pus. The antibiotics are recommended only if there is no possibility of making a correct diagnosis.

Suddenly, a painful mass has appeared in the anus. Which is the right diagnosis?

It is possibly, a thrombosed hemorrhoid. An immediate surgical opening will relieve you. If you don’t deal with it directly, you will have to wait until it is absorbed later.

Why do fistulas re-appear?

Fistulas indeed re-appear if they are not treated properly. A preoperative cartography with an ultrasound examination is required.

I feel severe pain after defecation (or 1 hour after that). What is the possible diagnosis?

You do not suffer from hemorrhoids. Probably, the right diagnosis is that you suffer from an anal fissure. The use of ice cubes is absolutely wrong. You have to wash up the area with warm water avoiding the use of toilet-paper or soap.

Is there a pap-test for the anus?

The anal cytology is necessary in a few subgroups where there is a high risk of anal cancer.

Which diseases cause bleeding from the anus?

Bleeding from the anus is maybe caused by hemorrhoids, anal fissures, polyps and malignant neoplasms of the intestine, diverticulum, vascular dysplasias and other diseases.

Is there any relation between anal cancer and warts?

Some types of the HPV can cause anal cancer and cancer in the area of the penis, the external female genitalia and the mouth.

Can heterosexual men appear anal warts?

A heterosexual man may have anal warts without having anal sex. HPV virus is found in the anus of heterosexual men at about 20% and is probably transferred from the penis by washing up.

Are hemorrhoids painful?

Hemorrhoids usually are not painful, but they can bleed and extend outwardly. They hurt suddenly and severely when they are clotted. The anal fissure is an illness of the anus which causes pain at a chronic basis, especially after defecation.

Do all hemorrhoids have to be operated?

Hemorrhoids are part of the normal tissue. If they get big and extended, they begin to bleed. By defecating in a right way, many of them can be treated well. The rest of them will need a surgical treatment, in our clinic or in a hospital surgery.

Why do some people feel itchy in their anus?

Usually, it is caused by toilet paper, soap or other liquids which are used to wash up the anal area.

When is a danger for anal cancer?

Anal cancer is likely to happen in gay men, those who are infected by HIV and anal warts, people who are under steroid and immunosuppressive medication, men who have frequently anal sex and women with a background of dysplasia in their genitalia. Smoking increases significantly the chances of dysplasia (precancerous situation).

Is there a non-surgical treatment for hemorrhoids?

If they are not very big, hemorrhoids can be treated with a simple banding. This medical procedure can be performed in our clinic in less than 10 minutes, easily and without anesthesia.

Where is HPV virus detected?

HPV is usually detected in the penis, the external female genitalia, the anus, the oral cavity and the tonsils.

What does HPV cause to the anus?

HPV causes anal warts (extended exophytic lesions). Some types of this virus cause precancerous dysplastic lesions which may develop into cancer. They have a flat shape and they are detected only after an appropriate staining and a microscopic examination.

Is HPV dangerous for our health?

Some types of this virus can cause cancer in the area of the anus, the external female genitalia, the oral cavity, the penis and the tonsils.

Do we need a colonoscopy to detect anal warts?

HPV infects only the skin cells. Anal warts can be found at a distance of only 5-6 cm from the entry of the anus. There is no need for a deeper checking of the intestine in order to detect an HPV infection.

Which virus is responsible for the appearance of anal warts?

Anal warts appear after an HPV (human papilloma virus) infection.

For how long do we sit on the toilet?

We have to use our toilet for just 5 minutes. We must not solve crosswords, surf the internet or do anything irrelevant while defecating.

How is HPV virus transmitted to humans?

The HPV is largely transmitted during anal intercourse and rarely directly by hand contact.

Does smoking worsen anal diseases?

Smoking predisposes to inflammation around the anus, like hidradenitis. It increases the presence of anal warts and precancerous dysplasia because it decreases the levels of immunity against the HPV virus.

Do hemorrhoids need a surgical treatment?

A small percentage of them need a surgical treatment. With proper defecation or simple invasive treatments without anesthesia, most of them are treated well.

Is there any available vaccine for HPV virus?

Yes, there are two types of vaccines and they must be applied under the age of 26 in men and women, especially in homosexual men.

Are there any preventive measures for anal cancer?

It is important to take preventive measures for the anal cancer, if the formed dysplasia are diagnosed and treated in the early stages.

Does the HPV infect any part of the intestine?

The HPV infects only the skin cells. Anal warts can be found at a distance of only 5-6 cm from the entry of the anus. There is no need for a deeper checking of the intestine in order to detect an HPV infection.

How often is the anus infected by the HPV in homosexual men?

The anal infection in homosexual men reaches an amount of 60%.

Is there any way for somebody to protect himself from an HPV infection during anal sex?

Actually, the condom cannot protect completely from an HPV infection.

How common is the anal cancer in human population?

The anal cancer is a rare disease except of high-risk groups. For instance, homosexual men have 20-times greater chance of developing anal cancer than the general population. Approximately 50% of HIV-positive gay men will present in their life pre-malignant dysplasia in the area of the anus.  10% of HIV-positive gay men will finally develop anal cancer.

What is the best treatment for anal warts?

Anal warts are treated by cauterization or removal. In some cases, ointments are indicated for removing them.

How can we diagnose properly the HPV infection and the anal warts?

An accurate diagnosis of warts and anal dysplasia can be achieved by performing a high resolution anoscopy after placing acetic acid in the anal area. All these dysplasia are diagnosed by performing a biopsy during the anoscopy.

In which case is the high resolution anoscopy recommended?

A high resolution anoscopy is recommended when the anal cytology results in suspicious findings. In our clinic, an HRA is performed always, especially when there is an existing high risk of dysplasia.

In which women is the anal cancer more likely to happen?

Anal cancer is more common in women with a history of significant dysplasia or cancer at the external genitals (cervix, vagina and vulva).

How are the anal fistulas appeared?

The anal fistula (perianal fistula) is a collateral communication between an external opening on the skin with an opening into the rectum (cause of the fistula) and can be likened to a tunnel.

When do anal fistulas appear?

Anal fistulas usually appear after the drainage (surgical or automatic) of the perianal abscess.

Can the anal abscesses re-appear?

If the perianal abscess is caused by an opening into the rectum (as it happens in most cases), the cause of the abscess will remain after its surgical incision.

How is the anal abscess diagnosed?

The exact location of the fistula (mapping) is discovered by performing an endo-anal ultrasound examination or an MRI (magnetic resource imaging). From our twenty-years experience, in our proctology clinic, we believe that the endo-anal ultrasound examination contributes to a better and more accurate understanding of the perianal fistula’s anatomy, compared to the MRI.

What can we identify by performing a fistula mapping?

Fistula mapping with the endo-anal ultrasound examination helps the colorectal surgeon to identify:

  • The cause of the perianal fistula (intra-anal opening)
  • The fistula tract and ramifications
  • The involvement of anal sphincters in the perianal fistula
  • Preoperative endo-anal ultrasound examination is mandatory in women (short sphincters-obstetric tear of sphincters)
  • In case of fistula recurrence (diagnosis of operative sphincteric trauma)
  • After a detailed mapping, surgical operation is safe and effective.

Which is the best treatment method for anal fistulas?

Surgical treatment is always the best way to manage anal fistulas. Treatment with antibiotics has temporary results and the problem (inflammation, abscess) may recur in a more extensive way.

In which way is a pre-operative diagnosis established for anal fistulas?

Before the syrgery, we have to proceed to a detailed mapping of the fistula tract by performing an endo-anal ultrasound examination. The results of the MRI are often unclear.

Which is the best treatment for simple and low fistulas?

The internationally recognized treatment for simple-low fistulas is lay-open. These low fistulas come to the surface through a small part of the external sphincter.

Are there any cases of anal fistulas where a difficult treatment is required?

When there is a case where the anal fistula runs through a significant part of the anal sphincter, then it is marked as high or inter-sphincteric. On this occasion, there is always a danger of fecal incontinence, so we cannot perform a simple lay-open technique on that fistula.

Which are the complications of anal fistulas’ surgeries?

If the ramifications or the anal opening are not treated, fistulas finally re-appear. If a significant part of the anal sphincter is divided, fecal incontinence may be a major complication of fistulotomy.

Which are the surgical techniques for treatment of high anal fistulas?

The best known techniques for the management of high anal fistulas are the following:

  • Staged division of anal sphincter (staged fistulotomy)
  • Insertion of a loop through anal fistula for drainage of the pus (loose seton technique)
  • Tightening of the seton loop for preservation of anal sphincter function (tight seton technique),
  • Insertion of collagen plug into the anal fistula (anal fistula plug). It has a chance of 50%,
  • Collagen plug insertion into fistula tract (anal fistula plug),
  • Closure of anal opening and reinforcement with a mucosal flap (success rate of 60%),
  • Mesosphincteric ligation of fistula tract (LIFT procedure) with documented good results in European and American clinics,
  • Closure of anal opening with OTSC proctology clip,
  • Closure of anal opening and cauterization of fistula tract with laser (FILAC).

Which are the advantages of laser’s use on anal fistulas?

Fistula laser closure (FiLaC®) is a simple, brief (up to 15 minutes), bloodless and painless method. Both of the sphincters (internal and external) are not injured, so fecal incontinence is completely avoided. It ensures the absolute control and precision during surgery and reduces the possibility of ablation or separation and all the associated risks of infection or other complications. At the same time, it requires minimal hospitalization (day clinic) and is ideal for the treatment of multiple relapses (in cases of failed surgical removals).  The dimensions of the cyst/fistula are not a limitation while the flexibility of the fibres ensures a good access to the cyst/fistula in order to be treated well even if the anatomy is difficult. The length of the fistula is not a limitation, while the laser’s energy accelerates the healing process. Also, the treatment can be combined with other techniques for the best closing of the opening point.

Can hemorrhoids cause anal cancer?

There is no correlation between anal cancer and hemorrhoids.