Haemorrhoids should be considered as an hypertrophy of the normal cushions (submucosa and vascular tissue) lying in the upper part of the anal canal.

Frequent disease with size increase for several reasons (pregnancy, constipation and straining, family history, prostate adenoma, food as spices and alcohol).

Common symptoms are bleeding during a bowel movement, pain, itching, prolapse or swelling.

An investigation with Anoscopy is necessary to stage the haemorrhoids and rule out other causes (such as anal cancer).

Identified stages of disease allow individual treatment to be adapted for each patient.

- Stage I (simple hypertrophy observed by Anoscopy): Medical Treatment (Fibers/ Laxative, Venotonic treatment, topics)
Rubber band ligation if symptomatic conducted in the private practice under local anaesthesia)

- Stage II (prolapse upon straining with spontaneous reduction): Medical Treatment
Rubber band ligation, or more often surgical treatment with Laser or with Selective Anopexy (“lifting of the haemorrhoids”)

- Stage III (Prolapse becomes permanent but can be digitally replaced): Surgical Treatment with Laser associated with mucopexy or Selective Anopexy or treated by conventional haemorrhoidectomy.
Circular stage III haemorrhoids:  Surgical treatment with circular mucosectomy by stapling (Longo).

- Stage IV (fibrotic haemorrhoids, irreversible): Surgical Treatment by conventional haemorrhoidectomy is necessary in general.
In case of acute haemorrhoid thrombosis an intensive medical treatment is mandatory, along with prescribed medications, laxative, flavonoïd, corticoid cream and local care. In a second step and after healing, a surgical treatment may be required.

A minimal invasive treatment with Laser associated with mucopexy if needed is a preferred treatment for heamorrhoids Stages II and III; less painful and with a speedy recovery.

When acute, a medical treatment of Fibers/ Laxative, Venotonic treatment, corticoid cream can be applied, or when painful, a Thrombectomy (evacuation of the clot) under local anaesthesia can be performed in the private practice.

Skin tags
Painless in general and benign. Frequent after thrombosed external haemorrhoids or after pregnancy. Local Treatment can be prescribed and avoiding local irritation. In case of persistent discomfort or chronic painful swelling, a surgical excision can be performed depending on the number of skin tags, under local or general anaesthesia.

A proctologic examination is mandatory to exclude any primary affection such as haemorrhoids, anal fissure or fistula, that cause irritation and itching.

Treatment by eradication of pinworms, removal of all local irritations (toilet paper, wipes, soap) and local cream.

In the acute stage, an anorectal abscess forms that requires drainage in emergency under local or general anaesthesia. In the chronic manifestation, it results in pain, purulent drainage, and a perirectal skin lesion with a risk on the anal sphincter and of incontinence at long term.

Anorectal fistula (or more rarely recto-vaginal fistula) requires a surgical treatment, classically the Seton drainage under general anaesthesia. It is maintained during 8-12 weeks for the purpose of providing controlled drainage, thereby allowing all inflammation to subside and form a solid tract of scar along the fistula tract.

The final operation, the fistulectomy may require a hospitalization for the complex treatment with reconstruction of the sphincter.

Chronical skin disease causing abscesses, scarring and chronic superficial fistulas originally from sweat glands involving the intertriginous skin of the armpits, groin, perianal and perineal regions. From unknown cause. Treatment is often difficult with stop smoking and local care. Drainage if abscesses, and/or antibiotics. Eventually, could require a local large excision of the unhealthy skin with flap reconstruction.

A gastroenterological follow-up and treatment is mandatory.  The perineal complication of the Crohn’s disease may include anal fissures, fistulas, and abscesses as perineal complications.

In the case of an abscess, a drainage is necessary under local or general anaesthesia. In the case of chronical fistula with discharge, a drainage Seton may be necessary.

In the acute manifestation of the disease, passing stools can be painful. Treatment consists of painkillers, laxative and local cream.  When chronic, after 6 weeks or recurrence, a surgical treatment may be necessary under general anaesthesia (fissurectomy plus mini-sphincterotomy in case of spasm of the sphincter).

An alternative can be a chemical sphincterotomy with “Botox” under local anesthesia.

A smear allows a targeted diagnosis and enables prescribed adapted antibiotic therapy.  The proctological examination allows to exclude complications such as abscess, fistula or ulcer.

The most common sexually transmitted disease is HPV (human papillomavirus) infection causing common genital wart-like lesions (condyloma).  These can be treated with cream or excised under local anaesthesia (LA) or general anaesthesia (GA).

Oncogenic HPV types 16 and 18 can cause long-term transformation to precancerous lesions (dysplasia).

High-resolution Anoscopy (as in gynaecology, with a microscope) makes it possible to detect and follow up precancerous lesions in the anus related to HPV and to prevent the development of anal cancer.  In case of doubt, biopsies are taken and then, depending on the result, an excision is performed under LA or GA.

Patients at higher risk require screening: HIV-positive patients (annual screening necessary), Immunosuppressant Drugs, patients with gynecological cancer or high grade cervical dysplasia. Screening recommended if condyloma.

Vaccination is recommended for girls and boys between 11-14 years of age (before sexual contact) up to 26 years old (for more information see website of the Federal Office of Public Health).

Anal cancer

Rare disease (1-2% of tumors of the digestive system, especially in women).  Risk factors are: Oncogenic HPV types 16 and 18, HIV-positive and immunosuppression.

Diagnosis is made by a biopsy that is required for any suspicious persistent lesion.

Proctological assessment with Anoscopy, Rectoscopy and endo-anal ultrasound.  More complete staging afterwards with pelvic MRI, thoracic and abdominal CT scan or PET  scan.

At an early stage, surgical excision is possible.  In the case of more extensive lesion, multidisciplinary discussions are mandatory for all oncological cases to establish the most appropriate treatment for the patient. In general radiotherapy coupled with chemotherapy.

Dyschezia, or difficulty passing stool, can lead to bowel incontinence.  It can be linked to old obstetric traumas, leading to lesions such as rectocele, intussusception, rectal prolapse, and even complex disorders of perineum.  A complete assessment by clinical examination, Anoscopy, perineal ultrasound and endoanal ultrasound, anorectal manometry and often defecography or defeco-Magnetic Resonance Imaging (MRI).

A multidisciplinary discussion with Urologist and Gynecologist may be necessary when urinary incontinence or gynecological problem are associated.

With every patient, physiotherapy is necessary for treatment of post-obstetric trauma.  For elderly patients, in general a medical treatment with hygienic, dietary and protective measures, is required.

Depending on the case and assessment, the surgical treatment may include rectocele plasty (posterior colpomyorraphy), sphincter repair (sphincteroplasty) or laparoscopic rectopexy and a recto-vaginal promontofixation. Or PTNS (Pre-Tibial Nerve Stimulation) or sacral neuromodulation are proposed.

Bleeding from the anus should not be underestimated.  It can be a sign of a possible tumour.  A proctologic examination completed by a Rectoscopy will exclude it.

Rectal tumour
Proctological assessment with Rectoscopy, endo-rectal ultrasound, then biopsy under general anaesthesia is necessary for diagnosis.

For all oncological cases, a multidisciplinary discussion is mandatory to establish the most appropriate treatment for the patient.  Usually, radiotherapy coupled with chemotherapy, followed by surgery.

Diagnosis is often difficult.  Proctological assessment is necessary for evaluation and to exclude other diseases. Follow-up of treatments include physiotherapy, stretching and infiltration.  For the management of chronic pain leading to impaired quality of life, multidisciplinary discussions will help define the most appropriate strategy.

Intergluteal pilonidal disease is a condition of younger people, usually men, with a high volume of body hair.  It results from hair penetration beneath the skin, for reasons that are unclear, with an inflammation near the upper part of the natal cleft of the buttocks.

The disease typically presents in the acute phase with abscess or when in a chronic process with “cysts” with draining sinus tracts.

An echography of the intergluteal cleft can assess the size of the “cyst” and the different fistula tract.

In case of acute abscess, a drainage is mandatory under local or general anesthesia.

After healing or in the chronic phase, definitive treatment is necessary to avoid secondary infections and a spread of the disease.

I offer revolutionary and minimally invasive technique with Laser to treat the pilonidal cysts, avoiding a large excision that requires a longer healing time and therefore an extended working leave period.  The treatment can be performed in the private practice under local anaesthesia.