Rectal Diseases & Proctology: Gentle Treatment of Hemorrhoids and Other Conditions

Rectal diseases are proctological conditions that affect the lower part of the large intestine and the rectum, as well as the anus and anal canal. This area is crucial for controlling bowel movements and retaining stool through the sphincter muscle. Inflammation, injury, or functional disorders can therefore quickly lead to symptoms such as itching, oozing, bleeding, or pain in the buttocks.

The most common diseases of the rectum include:

• Hemorrhoids
• Anal fissures
• Anal abscesses
• Anal fistulas & coccygeal fistulas
• Anal eczema
• Marisks
• Fecal incontinence

Some of these rectal conditions are acute, while others can become chronic and significantly impair quality of life.

The rectum serves as a storage site for stool. It is the lower portion of the large intestine and transitions into the anal canal, at the end of which lies the anal sphincter. Together with the pelvic floor muscles, the anal sphincter plays a key role in controlling bowel movements. It enables the retention of stool and flatus.

Inside the anal canal are well-vascularized cushions of tissue known as hemorrhoidal nodes. They support continence and help ensure the secure closure of the anus and rectum. If these vascular cushions become abnormally enlarged, hemorrhoids develop, which can lead to bleeding and a burning sensation.

Rectal diseases often affect the anus and the lowest part of the rectum, including the sphincter muscle. These conditions can be very painful and distressing for the patient.

Early diagnosis and treatment are crucial for preventing malignant rectal diseases and avoiding chronic conditions.

Rectal diseases often respond well to local and medical treatment with suppositories and ointments. In some cases, surgery is necessary.

The Anatomy of the Intestine © bilderzwerg | AdobeStock

The most common rectal diseases are listed below:

• Hemorrhoids
• Anal abscesses and anal fistulas
• Anal fissures
• Defecation Problems (Difficulty Passing Stool)
• Anal fistulas or coccygeal fistulas
• Marisks
• Anal eczema

Hemorrhoids and hemorrhoidal disorders

Everyone has hemorrhoids. Hemorrhoids are natural vascular cushions consisting of blood vessels that line the lower part of the rectum from the inside. They support the function of the sphincter muscle.

When a person suffers from hemorrhoids, these cushions often become inflamed, swollen, and enlarged.

The typical symptoms are

• bleeding,
• itching, and
• pain.

If they become very enlarged, hemorrhoids can also protrude outward beyond the anus (a condition known as prolapse).

Enlarged hemorrhoids can be very painful © Sagittaria | AdobeStock

Anal Fissures and Anal Fistulas

An anal fissure is a painful tear in the mucous membrane of the anal canal, usually caused by hard stools or excessive straining during bowel movements. If it does not heal, it can become chronic.

Anal fistulas are small passages between the anus and the skin that often develop after an anal abscess. They usually require surgical treatment, with experienced proctologists employing particularly gentle surgical techniques.

Coccygeal fistula and other proctological conditions

A coccygeal fistula is a chronic inflammatory condition in the gluteal fold that causes pain and discharge. Treatment is usually surgical, often performed today using the so-called keyhole technique.

Skin conditions such as anal eczema, skin tags, or anal vein thrombosis are also among the most common conditions in the anal region and are treated on a case-by-case basis with either conservative or surgical methods. 

Defecation Problems (Problems with Bowel Movements)

Patients with defecation problems are unable to control their bowel movements (fecal incontinence) or cannot completely empty their bowels despite the urge to defecate.

The causes of these anal disorders are complex. For example, the sphincter muscle may no longer function properly. As a result, it can no longer retain liquid or solid stool. This weakness of the sphincter muscle can result from

• childbirth involving an episiotomy,
• pelvic floor weakness, or
• surgeries such as a hysterectomy

.

Patients suffer from

• involuntary bowel movements,
• incomplete bowel movements, as well as
• itching, burning, and oozing in the anal area.

This leads to a severe, long-term impairment of social life.

Following a detailed discussion of the symptoms, the rectum is examined in several steps.

First, the anus is visually inspected and examined from the outside, followed by a digital rectal exam.

Before each examination, which lasts about 3 to 5 minutes, it is absolutely necessary to cleanse the rectum with an enema.

Although the examination is uncomfortable due to the insertion of instruments through the anus, it is not painful thanks to the application of a pain-relieving lubricant.

It takes place in a quiet, private room to ensure the patient’s privacy.

Rectal Endoscopy (Proctoscopy and Rectoscopy)

In both examinations, a straight instrument is inserted into the rectum. A proctoscope allows for the examination of the lower 5 cm of the rectum. It is used to examine hemorrhoids, fistulas, and fissures.

A rectoscope allows the entire rectum, which is approximately 15 cm long, to be examined. To ensure the rectum expands properly during the examination, air is pumped into it using a bellows.

Here you can see a colonoscopy. A rectoscopy works in the same way © bilderzwerg | AdobeStock

Sphincter Function Testing

To examine sphincter function, a pressure probe approximately 5 cm long is inserted into the anus. This allows for the measurement of resting pressure, maximum squeeze pressure, and sustained pressure.

Ultrasound of the rectum (rectal endosonography)

In certain cases, a direct ultrasound examination of the rectum is necessary. For this, a special probe is inserted into the rectum.

This examination allows for

• the sphincter muscle can be assessed in its entirety,
• the course of fistula tracts be identified, and
• the extent of tumors be determined prior to surgery.

Treatment for rectal conditions depends on the type and severity of the condition. Milder symptoms can often be relieved conservatively with ointments, sitz baths, and measures to regulate bowel movements.

In cases of severe symptoms, such as large hemorrhoids or fistulas, surgical intervention may be necessary. Modern surgical procedures are minimally invasive and are primarily performed on an outpatient basis to facilitate a quick recovery and minimize discomfort.

Proctology deals with the diagnosis and treatment of rectal diseases. Proctological conditions such as hemorrhoids, fissures, or eczema are often considered taboo topics, but they are generally treatable.

An experienced proctologist can provide targeted help using modern diagnostic methods and minimally invasive procedures to alleviate both acute and chronic symptoms. Early diagnosis and individualized treatment are crucial for preventing malignant rectal diseases, such as tumors. 

What are the most common rectal diseases?

The most common anal diseases include hemorrhoids, anal fissures, anal abscesses, and anal and coccygeal fistulas. They also include anal eczema, marisks, and fecal incontinence. Many of these conditions can now be effectively treated through minimally invasive procedures or conservative measures.

How does proctology treat hemorrhoids?

Depending on the severity, hemorrhoids are initially treated conservatively with ointments, sitz baths, or stool regulation. For severe cases of hemorrhoids, modern surgical procedures are used, most of which are performed on an outpatient basis.

Surgery is necessary when conservative therapies do not provide sufficient relief. Most surgical procedures are minimally invasive and are performed on an outpatient basis while preserving the sphincter muscle.