Causes of the Most Common Proctological Diseases

Interview with Dr. Pick-May

1. There are many proctological diseases. What are the most common causes?  

The most common causes of proctological diseases are irregular bowel movements due to an unbalanced, excessive, and low-fiber diet and irregular meals,
which particularly affect shift workers.
Lack of physical activity is not conducive to healthy digestion and can ultimately weaken the pelvic floor muscles.
Being overweight increases pressure on the anal area, which can promote various diseases.
Excessive or incorrect hygiene also promotes proctological diseases or skin irritations.

Pregnancies and childbirths are associated with hormonal changes and, together with the increased pressure from the child and childbirth, can lead to pelvic floor and muscle tone problems, which can then result in prolapse, tears, and enlarged hemorrhoids with corresponding hemorrhoidal disease.

Chronic inflammations such as Crohn's disease, infectious colitis, or perianal infections can also cause proctological problems.

In diseases of the anal glands, abscesses can occur acutely or fistula formations in the chronic form.

And of course, smoking and an unbalanced unhealthy lifestyle can promote inflammation and slow healing.

2. What should one expect during an examination, and does it require special preparation?

First, a thorough interview with the affected individuals about their symptoms, existing diseases, possible surgeries, childbirths in women, and family diseases is conducted. Very often, a preliminary diagnosis can be made based on this medical history alone.

This is followed by an examination, which very rarely requires preparation (emptying). For this, the affected individuals do not need to completely undress. Initially, only the external anal region is inspected, then very carefully palpated, and if necessary, a thin tube is used to look into the rectum, but only if there is no pain.

3. How do they develop

a) Hemorrhoids?

We all have hemorrhoids. They serve fine continence, i.e., they help retain liquids or gases.
They are located at the transition from the rectum to the anus. They are a ring-shaped vascular cushion, referred to in medical terms as hemorrhoidal plexus. This consists of blood vessels that swell or shrink as needed. Thus, they are part of the continence mechanism along with the sphincter muscles.

However, if there is an enlargement of the hemorrhoids and symptoms such as a foreign body sensation, itching, oozing, or bleeding occur, it is referred to as hemorrhoidal disease. Enlargement can occur due to increased pressure. This is mainly favored by a low-fiber diet, lack of exercise, and chronic constipation. Incorrect bowel habits, such as straining during bowel movements or prolonged “sessions” (reading on the toilet), can also promote the development of hemorrhoidal disease. On the other hand, adequate fluid intake aids positive bowel regulation.
In addition to these causes, there are other triggers for hemorrhoidal complaints: During pregnancy, but also after childbirth, hemorrhoidal complaints are often observed with enlarged hemorrhoids.

b) Pilonidal cysts?

It was previously thought that the condition known as sacral dermoid was a congenital disease arising from remnants of tissues left deep during embryonic development. Today, the pilonidal cyst is seen as an acquired disease of the subcutaneous tissue caused by ingrown hairs in the gluteal cleft (Rima ani). Hairs have small barbs, and one can imagine that they migrate deeper due to friction and pressure. Therefore, the disease is referred to in Turkish as the “disease of the inverted hair.” During World War II, it was also known in the American army as “Jeep driver's disease.” The hairs penetrate the skin, migrate into the subcutaneous tissue, and can cause inflammation. Over time, small openings can form externally, which we refer to as pores. Entire hair tufts can be found in the depth. A deep gluteal cleft and lack of hygiene opportunities promote its development. Extensive hair growth is not a prerequisite, as broken or fallen (head) hairs can collect and penetrate in the gluteal cleft. A similar condition is known from the navel and among hairdressers between the fingers.

c) Anal fistulas?

In the anal canal, there are so-called proctodeal glands. Their ducts can become blocked, leading to inflammation. In the acute stage, a perianal abscess can occur. If the disease becomes chronic, fistula tracts can form, which can lie between the anal canal and the surrounding area. They can lie just under the skin, pass through sphincter muscles, or lead around them. Secretions can repeatedly discharge from the external fistula opening.
A special form is the fistulas in chronic inflammatory diseases such as Crohn's disease. Treatment for these fistulas is partly medicinal in collaboration with gastroenterologists and very cautious regarding possible surgery.

4. What are the advantages of minimally invasive laser therapy?

The advantages of minimally invasive laser therapy are that, as the name suggests, they are minimally invasive. Thus, a smaller wound remains both externally and internally. As a result, patients experience less pain, healing occurs faster, and patients return to their pre-surgery state more quickly. Additionally, these procedures are often feasible under local anesthesia.

5. Can a recurrence be prevented?

This naturally depends on the condition.

For all diseases, the following applies: Preventive measures include a balanced and fiber-rich regular diet, ample exercise, plenty of drinking, and a balanced life. A normal body weight also contributes to prevention. Long toilet sessions should be avoided, as well as straining. This can be supported, for example, by taking fiber supplements such as ground psyllium husks.