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Hemorrhoids are the most common anorectal disorder and is the most common cause for the passage of bloody stools.Treatment is typically dependent on the degree of hemorrhoid protrusion and symptoms. Most cases generally respond to conservative medical treatment (e.g., dietary changes, sitz baths), or non-surgical procedures (e.g., infra-red photocoagulation). Thrombosed external hemorrhoids are usually characterized by anal pain, and therefore in-office surgical excision was commonly indicated. Large internal hemorrhoids can require evaluation for operating room surgery. These are associated with symptoms such as frequent bleeding and/or prolapse, as well as difficulty with the passage of bowel movements.Post-surgical pain is typically severe, out of proportion to the surgery itself. Frequently, narcotic analgesics have been used for the treatment of pain after surgery. Unfortunately such use can complicate recovery by causing constipation.Anal fissures are one of the most common causes of anorectal pain. Anal fissures are tears in the lining of the distal anal canal, usually along the middle back. The exact causes of anal fissures remain unknown. They are often associated with trauma, e.g., passage of a hard stool, but can also occur during bouts of diarrhea, childbirth, or ulceration of a hemorrhoid.The most common symptom of an anal fissure is pain at bowel movement, which can be quite severe and last for some time. Many acute anal fissures will heal within three weeks using treatments such as sitz baths, stool softeners, and analgesics (pain medication). However, it is common that anal tears do not heal as a result of such treatments, and in such cases it is possible that chronic anal fissures or anal ulcers are produced.Chronic anal fissures have not been typically responsive to conservative medical therapy, and therefore current treatments are frequently directed at surgical techniques. Healing occurs following surgery in many cases however, a large number of people experience significant pain and some incontinence (weakened muscle) following the surgical procedure. |