'recurrent fistulas'

Anal cancer is rare, but the number of new cases is rising. According to the American Cancer Society, in 2017, there are likely to be about 8,200 new cases, of which 5,250 will affect women and 2,950 will affect men. Around 1,100 people are expected to die from anal cancer, including 650 women and 450 men. Various risk factors are linked to anal cancer, but infection with two types of the human papilloma virus (HPV) appear to underlie 79 percent of cases. Anal cancer is rare before the age of 35 years. The average age of diagnosis is in the early 60s. Men have a 1-in-500 chance of getting anal cancer, and the risk is slightly higher in women. Symptoms and signs Diagram of the sphincter Common symptoms of anal cancer may include rectal bleeding noticeable if there is blood on feces or toilet paper pain in the anal area lumps around the anus, which may be mistaken for piles, or hemorrhoids mucus or jelly-like discharge from the anus anal itching changes in bowel movements, including diarrhea, constipation, or thinning of stools fecal incontinence, or problems controlling bowel movements bloating women may experience lower back pain as the tumor presses on the vagina women may experience vaginal dryness. Causes In anal cancer, a tumor is created by the abnormal and uncontrolled growth of cells in the anus. The anus is the area at the very end of the gastrointestinal tract. The anal canal connects the rectum to the outside of the body. It is surrounded by a muscle known as the sphincter. The sphincter controls bowel movements by contracting and relaxing. The anus is the part where the anal canal opens to the outside. The anal canal is lined with squamous cells. These flat cells look like fish scales under the microscope. Most anal cancers develop from these squamous cells. Such cancers are known as squamous cell carcinomas. The point at which the anal canal meets the rectum is called the transitional zone. The transitional zone has squamous cells and glandular cells. These produce mucus which helps the stool, or feces, pass through the anus smoothly. Most anal cancers are squamous cell carcinomas, but adenocarcinoma can also develop from the glandular cells in the anus. Risk factors Multiple risk factors have been studied that are linked to anal cancer. They include any or a combination of the following: Human papilloma virus (HPV): Some types of HPV are closely linked to anal cancer. Around 79 percent of people with anal cancer have HPV 16 or 18, and 8 percent have other types of HPV. Multiple sexual partners: This activity increases the risk of contracting HPV, which, in turn, increases the risk of anal cancer, which is a known risk factor. Receptive anal intercourse: Men and women who receive anal intercourse have a higher risk of developing anal cancer. Men who are HIV-positive and who have sex with men are up to 90 times more likely to develop anal cancer, compared with the general population. Other cancers: Women who have had vaginal or cervical cancer, and men who have had penile cancer are at higher risk of developing anal cancer. This is also linked to HPV infection. Age: Anal cancer, like most cancers, are more likely to be detected at an older age. A weakened immune system: People with HIV or AIDS and those who are taking immunosuppressant medications after a transplant are at greater risk. Smoking: Smokers have a significantly higher risk of anal and other cancers than non-smokers. Benign anal lesions: Irritable bowel disease (IBD), hemorrhoids, fistulae, or cicatrices have been linked to anal cancer. Inflammation resulting from benign anal lesions may increase the risk. Treatment Treatment for anal cancer will depend on various factors, including how big the tumor is, whether or not it has spread, where it is, and the general health of the patient. Surgery, chemotherapy, and radiation therapy are the main options. Surgery The type of surgery depends on the size and position of the tumor. Resection The surgeon removes a small tumor and some surrounding tissue. This can only be done if the anal sphincter is not affected. After this procedure, the person will still be able to pass a bowel movement. Abdominoperineal resection The anus, rectum and a section of the bowel are surgically removed, and a colostomy will be established. In a colostomy, the end of the bowel is brought out to the surface of the abdomen. A bag is placed over the stoma, or the opening. The bag collects the stools outside the body. A person with a colostomy can lead a normal life, play sports, and be sexually active. Chemotherapy and radiotherapy Most patients will probably need chemotherapy, radiation therapy, or both. Radiation therapy may be combined with chemotherapy to destroy anal cancer cells. Treatments may be given together or one after the other. This approach increases the chance of retaining an intact anal sphincter. Survival and remission rates are good. Chemotherapy uses cytotoxic drugs that prevent the cancer cells from dividing. They are given orally or by injection. Radiotherapy uses high-energy rays that destroy the cancer cells. Radiation can be delivered internally or externally. Radiotherapy and chemotherapy have adverse effects, and combining them may make the side effects more acute. Side effects may include: diarrhea or constipation soreness and blistering around the target area, which is the anus a higher susceptibility to infections during treatment fatigue loss of appetite nausea or vomiting mouth ulcers or sore mouth loss of hair narrowing and dryness of the vagina a low white blood cell count, increasing the risk of infection anemia, due to a low red blood cell count a low platelet count, raising the risk of bruising or bleeding dry skin rashes muscle and nerve problems excessive coughing and sometimes breathing difficulties fertility problems

Anal Fistula When an irregular false tract occurs between the inside of the rectum and the outside skin surface, an Anal Fistula forms. The anal fistula is classified according to the condition of the tract and the relation of the internal opening to the anal sphincter muscle. Most commonly, this condition develops because of an anal abscess that went untreated. The anal abscess itself is usually the result of a small gland that becomes infected. The most common symptoms are pain, recurrent swelling, pus discharge and discomfort during the discharge of stool. The most common treatment in India is a surgical treatment; the most common method is the minimally invasive Video Assisted Anal Fistula Treatment. Symptoms What are the typical symptoms of anal-fistula? Swelling around the anal area Redness around the rectal area Pus drainage Rectal pain. Causes What causes anal fistulas? It usually occurs as a result of some damage to the tissue around the anus. It begins as a sort of inflammation in the rectal area. Later, it becomes an abscess which gets regularly infected and reinfected by faeces. This causes the fistula to form near the anus. If the fistula seals over, pus can start accumulating. Because of this pus-drain, anal fistulas can be very painful. Anal fistulas usually occur because of: An injury caused by constipation Anal glands becoming infected Crohn’s disease Abscess of the large intestine

When the skin of the anus gets cut or damaged, that is called an anal fissure. It is very similar to what happens when our dry lips get chaffed. Fissures typically bleed and cause pain, which is why they are often confused with haemorrhoids/ piles. When the anal muscles are stretched too far, it usually causes strain on the anus. This can occur to people who suffer from constipation or prolonged diarrhoea. It also occurs for older patients due to decreased blood flow to the anal area. It is not uncommon for women to develop anal fissures after giving birth as well. And it can also happen to people who have Crohn’s disease. With more severe cases of anus tearing, an external lump will form on the anus. These are the sentinel piles tell-tale of chronic fissures. The issue of anal fissures can be solved by medicine or by surgery and also by laparoscopic treatment. Symptoms Some signs and symptoms of anal fissures : Pain during bowel movement Pain after the bowel movements Blood on the stool or toilet paper Anal itching Visible damage to the skin of the anus A small lump that’s close to the anal fissure. Treatments Chemical Sphincterotomy Chemical Sphincterotomy is basically a Botox Injection for anal fissures; it is a very common Treatment for Anal Fissures. If the anal fissure doesn’t heal, it’s usually because of the spasm of the internal anal sphincter muscle which reduces blood supply to that area and further aggravation occurs to the fissure during the passage of motion through a spasmodic anal canal. The Botox is injected into the anal sphincter. This injection is used to prevent spasm and cause temporary paralytic relaxation until the tissues are renewed. The effects last for three months and the anal fissure heals during that time. Percutaneous Closed Lateral Internal Sphincterotomy This surgery, popularly known as CLIS, is a quick minimal invasive surgical method performed by specialized doctors under local anaesthesia that is used to treat chronic anal fissures. It is performed on the internal part of the anal muscle, the internal anal sphincter. The surgical procedure basically lowers the pressure of the internal anal sphincter and the spasm is reduced by dividing this internal anal sphincter. The fissure is healed because anal spasm is lowered and blood flow to the area is improved. Due to the closed technique, the wound is smaller and it heals faster.