#गुदा #द्वार के रोग : #बवासीर #फिशर #फिस्टुला क्यों होते हैं? #hemorrhoids #fistula #piles #fissure

Dr. Abhishek Shukla (Geriatrician) with Dr. Sandeep Kumar (Professor of Surgery & Founder Director AIIMS, Bhopal) today discussed common Ano-Rectal problems for Students from Fatima Institute of Nursing. Common anorectal diseases encompass hemorrhoids (piles), anal fissures, anal fistulas, perianal abscesses, pruritus ani, proctalgia fugax, and fecal incontinence. These afflictions predominantly stem from chronic constipation, straining at stool, prolonged sitting, low-fiber diets, pregnancy, obesity, or underlying conditions like inflammatory bowel disease or cryptoglandular infections, which elevate intra-abdominal pressure, provoke ischemia, or foster bacterial overgrowth. Hemorrhoids arise when anal cushions engorge due to venous congestion from sustained straining, leading to painless rectal bleeding, prolapse, or mucus discharge. Anal fissures develop from trauma by hard stools or sphincter hypertonia, manifesting as excruciating burning pain lasting over 30 minutes post-defecation, often with minimal bleeding and a sentinel pile on exam. Fistulas typically evolve from untreated perianal abscesses—obstructed anal glands that suppurate—creating persistent tracts with recurrent pus discharge, swelling, and discomfort on sitting. Abscesses present acutely with throbbing pain and fever, while pruritus ani involves relentless itching from moisture, poor hygiene, or dermatoses. Differentiation hinges on clinical history, symptoms, and targeted exam. Piles feature bright red bleeding without severe pain or pus, visible as bluish cushions at the verge. Fissures cause lancinating agony during defecation sans prolapse or purulent discharge, confirmed by posterior midline ulcer on gentle DRE. Fistulas signal chronicity with external openings yielding pus, guided by Goodsall's rule; unlike piles or fissures, they follow abscess resolution. Proctoscopy or MRI aids complex cases, distinguishing piles' vascular nature, fissures' spasm, and fistulas' infectious tracks. Management starts conservatively: fiber supplementation, stool softeners, sitz baths, and hygiene. Refractory piles warrant banding or hemorrhoidectomy; fissures, botox or sphincterotomy; fistulas, fistulotomy or seton placement. Vigilant intervention averts complications like thrombosis, incontinence, or malignancy