Benign Diseases of the Anus and Rectum

Mount Sinai’s colon and rectal surgeons have extensive experience in benign (non-cancerous) conditions occurring in the anus and rectum, including hemorrhoids, anal fistulas, and anal fissures. If surgery becomes necessary for these conditions, our doctors are skilled in minimally invasive techniques, most of which concentrate on sphincter preservation.

Hemorrhoids

Hemorrhoids are swollen veins located in the lower part of the rectum or anus. They could be caused by straining during bowel movements, pregnancy, or prolonged sitting, and symptoms include bright red blood from the rectum, anal pain or itching, and one or more lumps near the anus.

Surgery for Hemorrhoids

In most cases, hemorrhoids can be treated with outpatient procedures performed in the doctor’s office. However, if you have hemorrhoids that are located outside the rectum, are complicated by another disorder, or if they are not improving with medication or self care, your doctor may recommend surgery. In severe cases, Mount Sinai colon and rectal surgeons may perform what is called an excisional hemorrhoidectomy, in which a speculum is inserted into the anus to remove the hemorrhoid and close the remaining wound with a suture that can be absorbed by the body.

Your surgeon might also recommend a circular stapled hemorrhoidopexy, in which the tissue above the hemorrhoids is removed, pulling the hemorrhoids back up into place. Removing a thrombus, or a blood clot, is another common surgical procedure that may be recommended to relieve pain, when appropriate.

Anal Fistula

An anal fistula forms when an anal abscess that has been drained does not heal completely. An anal fistula has an internal opening in the anal canal and an external opening in the skin near the anus. Symptoms of an anal fistula include swelling and pain near the anus, and pain associated with bowel movements.

Surgery for Anal Fistula

There are a number of surgical options for treating an anal fistula. Once your surgeon has located the fistula’s internal opening, the standard procedure involves opening the tract, cleaning out its contents, and stitching its sides. If there is a significant amount of sphincter muscle affected, or if the entire tract cannot be located, your surgeon may perform this operation in more than one stage.

Mount Sinai colon and rectal surgeons have extensive experience with several fistula procedures that do not cut away sphincter muscle, including a fistula plug, advancement flap, and ligation of the intersphincteric fistula tract (LIFT). Other procedures include seton placement, where your surgeon uses a silk string to either create scar tissue to reduce the amount of sphincter affected or to help the fistula drain. Your surgeon may also use a plasma based protein glue (fibrin glue) to heal the fistula.

Anal Fissure

An anal fissure is a tiny tear or split in the lining of the lower rectum. Often caused by passing a large, hard stool or having chronic diarrhea, anal fissure symptoms include pain during bowel movements and bleeding. Many anal fissures can be healed without surgery by using treatments that include topical medications and Botox injections.

Surgery for Anal Fissures

In some cases, your doctor may decide surgery is the best treatment option for an anal fissure. Colon and rectal surgeons at Mount Sinai may perform a lateral internal sphincterotomy, which involves creating an incision at the side of the anus, so as to relax the muscle and allow the fissure to heal. In rare cases, the fissure may be surgically removed if scar tissue has formed.