Mariscuses are lobular folds of skin that are located on the outer, visible area of the anal ring. They occur in different sizes, individually or in groups and can have a wreath-shaped arrangement.
You can find out which doctor treats mariscus and what the symptoms, diagnosis and treatment of mariscus look like here.
Mariscus are enlarged folds of skin in the anal area that are partially visible from the outside. The skin folds usually consist of soft or sagging skin. However, they can also swell and develop rough lumps - especially in the case of chronic inflammation, heavy pushing due to hard bowel movements or other pressure on the anal ring.
The causes for the development of these skin changes in the anal area are only partially known. In general, diseases and conditions in which there is increased pressure in the rectal area (e.g. chronic constipation, pregnancy, childbirth) are risk factors for the development of mariscus. In some cases, they are a concomitant symptom of the following proctologic (rectal) diseases:
In general, skin lobules occur in around 60 percent of the population - more frequently in women and on average from the age of 20, in men from the age of 40.
Mariscus are often confused with enlarged haemorrhoids by non-medical professionals and those affected. However, they are different clinical pictures. Hemorrhoids are ring-shaped vascular cushions supplied by arteries under the rectal mucosa. They do not represent a disease, but ensure the fine closure of the anus and continence, i.e. the controlled retention of bowel movements. Only a significant enlargement of haemorrhoids is pathological, especially if they protrude from the anal canal and are externally visible. Doctors then refer to this as hemorrhoidal disease.
In contrast to haemorrhoids, mariscus are not vascular cushions, but merely flaccid, outwardly protruding parts of the anal canal skin. In the case of haemorrhoidal disease, however, the skin of the anal canal can be displaced outwards. Accordingly, skin changes on the anal ring can be an indication of an underlying hemorrhoidal disease. Mariscus can be a consequence of hemorrhoids.
Mariscus (small fold) at the anus © Armin Kübelbeck, CC-BY-SA, Wikimedia Commons
As mariscus occur more frequently in diseases with increased pressure in the anal area, pregnancy and childbirth are considered an important risk factor for the development of mariscus.
Mariscus can develop particularly after pregnancy or childbirth. It is mainly women who have given birth several times who notice skin changes in the anus area. However, mariscus can also develop during pregnancy as a result of hormonal changes, as the anal skin becomes softer and swells due to water retention. The additional pressure on the pelvic floor can cause parts of the anal skin to shift outwards and form wrinkles. While the water retention disappears again, the externally visible skin folds often remain after pregnancy.
Mariscus are generally harmless and usually do not cause any discomfort. They are therefore more of a hygienic and cosmetic problem .
However, if anal hygiene is severely impaired by the skin lobules, mariscus can also lead to problems. This is because impaired anal hygiene increases the risk of infections, for example caused by bacteria or fungi.
Typical symptoms caused by mariscus can then be
Mariscus can be diagnosed very easily, as it is a so-called "visual diagnosis". They are usually visible to the naked eye and can be diagnosed during an inspection (medical term for a simple examination) of the external anal region. Consequently, no further instrumental examinations are necessary to diagnose mariscus.
However, as mariscus is sometimes associated with other diseases of the rectum, as mentioned above, the anal and rectal area is nevertheless carefully checked. A digital examination (palpation with a finger) is recommended in order to detect any abnormalities. This allows any additional haemorrhoids or hidden cracks (anal fissures) to be identified. Anal thromboses, anal carcinomas and benign connective tissue tumors can also be associated with mariscus.
If suspicious findings such as palpable wall thickening, pain or bleeding are detected during palpation of the anal canal alone, an endoscopy of the rectum (rectoscopy) or the entire colon (colonoscopy) is usually arranged.
As mariscus are harmless, treatment is only necessary in rare cases. In any case, careful and gentle hygiene of the anal area is recommended. You should clean your anal area with a damp cloth after a bowel movement. Use clean water (on toilet paper or disposable washcloths) and avoid using soaps or disinfectants. Moist toilet paper can also cause skin irritation due to the preservatives and fragrances it contains. Always dry the anal region carefully.
A zinc ointment can be used in the short term if discomfort occurs. If anal eczema has developed, you can treat it with hemorrhoidal ointment or oak bark or chamomile baths. Have yourself examined by a proctologist if your symptoms do not improve or persist. Surgical removal of the mariscus(mariscene excision) is only recommended in cases of difficult anal hygiene with secretion congestion and diseases of the anal skin. The skin lobules are removed with an electric knife under local anesthesia. Even in the rare cases in which mariscuses
surgical measures may be necessary.
No major complications are to be expected, even in the case of mariscus requiring surgery, and the prognosis is very good. Post-operative bleeding from the small blood vessels may occur, which in most cases resolves itself.
Closure of the surgical wounds is often accompanied by pain, as an infection (inflammation with a small focus of pus) usually develops in the operated area and the wounds become tense. You will therefore be given a painkiller by your doctor. If the pain is too severe and the operated area swells, antibiotic therapy is indicated.
A wound dressing with a disinfectant and ointment will be applied during the operation. You will continue this wound treatment (compress plus disinfectant and ointment) at home after the operation. You can also promote wound cleansing and healing by using sitz baths and showering several times a day.
One and four weeks after the operation, the attending physician will monitor wound healing. The first signs of healing should be visible after two to three weeks at the latest. After complete healing, you will normally no longer be able to see anything of the procedure. As a rule, you will be unable to work for 2 weeks. If adequate anal hygiene is not possible due to your job, you may be unable to work for longer.
In principle, it is possible for mariscus to recur. This applies both in cases where mariscus has been operated on, but also and especially without surgery. There is no patent remedy that can prevent mariscus. However, it is possible to minimize the risk through stool-regulating measures, plenty of exercise and a healthy, high-fibre diet. As a sedentary lifestyle and being overweight also increase the risk of developing mariscus, a lot can also be achieved by changing lifestyle habits accordingly. However, there is no guarantee.
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