Proctology


Proctology deals with the diagnosis and treatment of diseases of the rectum. Common diseases of the rectum include hemorrhoids and anal fissures. In our center for proctology we offer you competent and comprehensive consultation, diagnostics and the complete therapy spectrum for all diseases of the rectum.

Consultations, examinations and minor procedures take place in our practice. For certain examinations (e.g. colon and gastroscopy) we work closely together with gastroenterologists and other specialists. Should an operation be necessary, we perform it at our exclusive clinic partner Merian-Iselin-Clinic in Basel.

Hemorrhoids



Hemorrhoids are one of the most frequent diseases in the western population. About 70-75% of the people will suffer from problems of their hemorrhoids at least once in their lifetime. Hemorrhoids are blood vessel cushions in the distal area of the rectum, where they help to seal the rectum against inadvertent loss of fluid and air. Hemorrhoids can become symptomatic when they increase in size. The typical symptoms are bleeding and sometimes itchiness. Only rarely they develop a size where they prolapse out of the anus. The common causes for enlarged hemorrhoids are constipation, lack of physical activity, long sitting and unhealthy diet. The treatment strategy depends on the symptoms and the size of the hemorrhoids. In most cases the elimination of the risk factors in combination with local medication (suppositories, creams) are sufficient. In in the case of continuously bleeding a rubber band ligation can be performed. Only in larger prolapsing cases we have to surgically remove the hemorrhoids.

  • Conservative treatment
  • Rubber band ligation
  • Laser-coagulation of hemorrhoids
    (Operation after Ferguson or Milligan Morgan)
  • Surgical resection of hemorrhoids
  • Surgical stapler resection of hemorrhoids

Hospital stay: 2 days for complex cases
Otherwise outpatient treatment in our practice OR

Sinus pilonidalis (sacral dermoid)


The pilonidal sinus is a very frequent disease especially among the male population. Here, hairs in the anal cleft penetrate the skin and continue to grow subcutaneously. This causes tunnels and cysts under the skin, where tuft of hair can collect. The entrance of the penetrating hair can often be seen as a porus in the anal cleft. Sometimes, hair can be pulled out of the porus. The symptoms of the pilonidal sinus can range from completely asymptomatic sinuses, to fluid discharge and acute inflammation (abscess formation). A surgical treatment is only necessary when symptoms appear. The aim of the therapy consists of the complete excision of the pilonidal sinus in the most minimal invasive way. In many cases the pilonidal sinus can be treated using a laser (Sinus Laser Therapy, SiLaT) or with minimal excision (sinusectomy). In larger, complex cases a complete excision with skin flap reconstruction is necessary.

  • Minimally-invasive techniques
  • Radical surgical excision and primary closure (Bascom / Karidakys operation)
  • Excision and flap techniques (Limberg-flap, V-Y-plastic)
  • Incision of pilonidal abscesses

Hospital stay: 2 days for complex cases
Otherwise outpatient treatment in our practice OR


Anal fissure


The anal fissure is a tear in the very sensitive skin of the anus. This tier usually develops due to hard stool during phases of constipation. Typical symptoms are intense pain and bleeding during bowel openings. 95% of anal fissures heal on their own. The therapy consists of local and systemic analgesia, reduction of the sphincter muscle tonus and the elimination of risk factors (e. g. constipation). Chronic anal fissures without healing after three months should undergo surgical excision.

  • Conservative treatment
  • Surgical debridement of the fissure
  • Surgical resection of the fissure
  • Relaxation of the sphincter muscle using BTA

Outpatient treatment in our practice OR


Anal fistulas



Anal fistulas are connections between the rectal mucosa and the skin around the anus bypassing the anal canal. They usually develop following an acute perianal abscess. Through the internal opening of the fistula feculent fluid enters the fistula tract and appears at the perianal skin. Due to this permanent feculent contamination of the fistula the process is kept in chronic inflammation and can never heal. Therefore, an anal fistula can only be cured with surgery. The surgical therapy usually consists of two procedures. During the first operation the fistula tract is detected and secured with a comfort drain. This drain remains in the fistula tract for three months and prevents retention of feculent fluid and further inflammation of the fistula tract. After subsiding of the inflammation of the fistula tract the second operation aims to close the fistula. The applied surgical technique depends on the course of the fistula tract.

  • Sphincter-preserving Laser coagulation of the fistula tract (FiLaC)
  • Sphincter-preserving fistula plug
  • Closure of the fistula with a ligation (LIFT operation)
  • Closure of the fistula with mucosa advancement flap (so called Mucosaflap)
  • Surgical excision if the fistula tract (fistulectomy)
  • Lay-open fistulectomy
  • Closure of internal fistula orifice using clips (OVESCO clips)
  • Closure of the fistula tract using paste

Hospital stay: 2 days for complex cases (sphincter reconstruction, mucosa flaps)
Otherwise outpatient treatment in our practice OR


Incision of pilonidal abscesses

  • Conservative treatment
  • Surgical incision

Anal skin tags

Anal skin tags are harmless folds of skin on the anus and are a very common finding. They usually develop as a result of major anal vein thrombosis (e.g. during pregnancy, constipation). These skin folds are hardly noticed by most patients and therefore often require no treatment. In some cases, however, symptoms may occur. These include itching, a feeling of dampness, swelling or difficulties with toilet hygiene. Changing anal hygiene to douching can improve anal hygiene problems in most cases. Sometimes, however, a small outpatient operation is necessary. The skin tag is then removed under local anesthesia. The wound must then heal openly, which can take 4-6 weeks.

Treatment

  • Adaptation of toilet hygiene
  • Surgical removal

HPV infections (Human papilloma virus) and genital warts (condylomas)


The human papilloma virus (HPV) is a virus that only affects the skin of the anogenital tract (penis, vagina, cervix uteri, anal region). Transmission occurs through direct contact, usually during sexual intercourse. HPV infection is therefore classified as a sexually transmitted disease (STD). In rare cases, transmission can also occur in public toilets or saunas. More than 200 types of HPV are known. The viruses can be divided into a group with a high risk (e.g. HPV types 16 and 18) and a group with a low risk (e.g. HPV type 6 or 11) for the development of precancerous lesions of the infected skin. When infected, the virus causes the skin cells to change. Patients infected with the “low-risk” HPV usually develop condylomas (so-called genital warts). Although these are unpleasant, they hardly increase the risk of cancer. Infection with a “high-risk” HPV can lead to the development of precancerous lesions (so-called AIN, CIN etc.) and later cancer (so-called anal carcinoma), especially in high-risk patients (e.g. with HIV infection or immunosuppression).


Infection usually occurs during sexual activity in adolescence. It is assumed that almost teenagers become infected with HPV unnoticed unless they are vaccinated. Vaccination against HPV is therefore recommended for teenage boys and girls. In most cases, however, the HPV infection is defeated by the immune system and the disease never develops. In about 10% of cases, however, skin lesions develop. Treatment is aimed at removing the affected areas of skin and can take several interventions over a longer period of time. Condylomas can, for example, be iced or, in the case of larger infestations, removed using a scalpel. If a precancerous leasing (e.g. AIN) is suspected, we carry out a high-resolution camera examination of the affected skin and take small skin samples, which are then examined by a pathologist. Patients at risk (e.g. HIV infection) should therefore be examined annually as part of an AIN screening.

Examination and treatment

  • Genital warts
    • icing
    • surgical removal
  • AIN
    • brush cytology
    • resection
    • annual check-up of high-risk patients using high-resolution video anoscopy (HRA)

Anal carcinoma

The anal carcinoma is a rare but malignant disease of the skin of the anus. around 200 people develop this disease per year in Switzerland. women are at higher risk for developing this disease. the anal carcinoma develops from the skin cells of the anus, in some cases they can develop from the mucosa and the gland cells of the rectum. Most important cause for anal carcinoma is an untreated infection with HPV (Human Papilloma Virus). The diagnostics consists of a careful anal examination including high resolution anoscopy and biopsies. Once the diagnosis has been confirmed by pathological examination of the biopsies the local and systemic extend of the disease (tumor stage) must be evaluated using MRI scans of the pelvis and CT scans of the abdomen and lungs. The treatment strategy is highly depending on the tumor stage and will be discussed with an interdisciplinary team of doctors. The prognosis of the anal carcinoma has improved and is better the earlier the disease is discovered. In most cases a combined radio-chemotherapy is sufficient to treat the disease. In some cases, surgery is necessary too.

  • Interdisciplinary diagnostics and treatment

Anal and rectal prolapse

These conditions cause the mucous membrane of the anal canal (anal prolapse) or rectum (rectal prolapse) to slip out of the anus, which usually has a significant impact on quality of life. The cause is pelvic floor weakness, which can occur more frequently after several pregnancies and in old age, for example. In addition to the mucous membrane slipping out of the anus, there is often oozing, bleeding and incontinence for urine or stool. Treatment depends on the symptoms. In addition to a thorough proctological examination, diagnostics may also include a colonoscopy or an MRI examination of the pelvis (so-called MR defecography). The aim of treatment is to improve the quality of life and control the disturbing symptoms. In many cases, stool regulation and pelvic floor physiotherapy can already resolve the problems. In some cases, however, depending on the severity of the prolapse, surgery may be necessary.


Anal incontinence

Anal incontinence is a very frequent problem especially among elderly woman, which have given birth. The patients suffer from inadvertent loss of stool, gas, and mucus. The quality of life is reduced in most cases, since patients are fearing to go outside and meet friends because of a “potential accident”. The grad of the anal incontinence is measured using the “Vaizey-Wexner” score. Also, the disease is divided into a primary incontinence (damage to the nerves which regulate the sphincter muscle function) and secondary forms of incontinence (e. g. insufficiency of the sphincter muscle, pelvic floor disorders or chronic constipation). Beside detailed history taking and assessment of the grade of anal incontinence a careful rectal examination will confirm the diagnosis. Sometimes, imaging modalities such as MRI scans or endoanal ultrasound as well as functional tests (endoanal manometry) are necessary. The treatment is highly depending on the cause for the incontinence and the psychological strain. In many cases pelvic floor physiotherapy or stool regulation are sufficient. Rarely an operation is indicated.

  • Conservative treatment
    – Pelvic floor physiotherapy
    – Biofeedback training
    – Stool regulation
  • Surgical sphincter reconstruction
  • Minimally-invasive silicone implants
  • Radiofrequency ablation (RFA, Secca-operation)

Anal itching

Anal itching (Pruritus ani) is a very common symptom and can have various causes that should be clarified by a doctor. The most common cause is small skin lesions on the anus, e.g. caused by very intensive wiping with normal toilet paper. Sometimes a little blood can also be seen on the toilet paper. These skin tears then become inflamed, excrete secretions and thus moisturize the otherwise dry skin on the anus. This results in the typical burning and itching of the anal skin, which is then further aggravated by further wiping. Other causes of itching can be infections with parasites (worms) or primary skin diseases (e.g. eczema, psoriasis).


Constipation and diarrhea

The normal frequency of defecation ranges from 2-3 x per day to 2-3 x per week and is highly depending on individual factors such as eating habits or lifestyle. The stool should be soft but formed. In most people there are periods if constipation or diarrhea for various reasons, which subside after a few days. However, in some cases these problems can persist. Around 15% of the western population suffer from chronic constipation. The stool is hard, impeding the defecation process, which is sometimes accompanied by flatulence or abdominal pain. The constipations can be caused by unhealthy diet, lack of physical activities, lifestyle impairments (e. g. shift working), unhealthy defecation habits, pregnancy and breast feeding, menopause, or abuse of laxatives. Sometimes, constipation can also be caused by functional disorders of the large bowel (e. g. slow transit constipation) or by mechanical barriers in the rectum. The therapy aims on the elimination of the causing problem.

Diarrhea is defined as defecation more than 3x per day with a liquid or fluffy consistence. Here, several aspects of the lifestyle and eating habits can cause the problem. In some cases, chronic inflammatory bowel diseases, an infection with bacteria or viruses, or food poisining can be source of the diarrhea.

  • Consultation
  • Identification of constipation and diarrhea source
  • Development of treatment strategies