Proctology

The Proctology Department at the University Clinic for Visceral, Transplant, and Thoracic Surgery in Innsbruck specializes in the diagnosis and treatment of diseases in the rectal and pelvic floor region. As part of our Pelvic Floor Center, we offer comprehensive care for patients with various proctological and functional disorders in close cooperation with the University Clinic for Gynecology and the University Clinic for Urology.

At the University Clinic for Visceral, Transplant, and Thoracic Surgery in Innsbruck, we offer treatments for these disorders, among others:

• Anal fissure
• Anal fistula
• Hemorrhoids
• Pilonidal sinus
  
• Functional disorders
  • Emptying disorders
  • Fecal incontinence

Anal fissure

• An anal fissure is a painful injury or tear in the area around the edge of the anal canal. These injuries can be caused by various factors such as chronic constipation, diarrhea, excessive straining during bowel movements, or trauma.
• Symptoms: Severe pain during or after bowel movements, bright red blood on toilet paper or, rarely, on stool, burning or itching in the anal area
• Diagnosis: Anal fissures are usually diagnosed through a medical history and rectal examination. These examinations can help determine the location, size, and severity of the fissure and rule out other possible conditions. In some cases, additional diagnostic procedures such as a proctoscopy may be necessary to make an accurate diagnosis.
• Treatment: Treatment for anal fissures initially involves conservative measures such as a high-fiber diet, adequate fluid intake, warm sitz baths, and ointments containing local anesthetics and muscle relaxants. These measures often produce good results in cases of acute fissures. Surgical repair may be necessary for chronic or treatment-resistant anal fissures. 

Anal fistula

• An anal fistula is an abnormal connection between the anal canal or rectum and the skin around the anus. It often develops as a complication of a previous anal fissure, anorectal abscess, or other inflammatory processes in the anal area.
• Symptoms: Persistent pain in the anal area, discharge of pus, blood, or secretions, painful lump around the anus.
• Diagnosis: Anal fistulas are diagnosed through a thorough medical history, physical examination, and proctoscopy. Additional imaging techniques, such as 3D endosonography or magnetic resonance imaging, may be necessary to determine the exact location and extent of the fistula.
• Treatment: Anal fistulas often require surgical treatment. The type of procedure depends on the location, complexity, and extent of the fistula. Typical procedures include fistula division and fistula excision. In some cases, a seton (thread drainage) is used to stabilize the fistula. In complex cases, sphincter reconstruction or an advancement flap is necessary. 

Hemorrhoids

• Hemorrhoids are a common condition characterized by excessively swollen vascular cushions in the anal canal.
• Symptoms: Itching, burning in the anal area, anal pain, bleeding during or after bowel movements
• Diagnosis: A proctological examination, including medical history and physical examination, is necessary to confirm the diagnosis. In addition, a proctoscopy is performed to assess the severity and rule out other diseases.
• Treatment: Hemorrhoids are primarily treated conservatively using non-surgical measures such as a high-fiber diet, adequate fluid intake, toilet training, ointments, and flavonoids. In advanced cases or if symptoms recur, various surgical procedures may be necessary. We take a tailored approach and combine various procedures such as open hemorrhoidectomy and mucopexy. In addition, we offer Longo’s stapler hemorrhoidopexy for severe circular hemorrhoids.

Pilonidal sinus

• The pilonidal sinus, also known as a pilonidal cyst, is an inflammatory condition that typically occurs in the gluteal cleft. It is caused by hair penetrating the skin and forming an abscess or fistula.
• Symptoms: Pain in the buttock crease area, swelling and redness of the affected area, pus or discharge in the coccyx area
• Diagnosis: Pilonidal sinus is diagnosed through a clinical examination of the affected area. Imaging techniques such as ultrasound or magnetic resonance imaging may also be necessary to assess the extent of the inflammation and the presence of fistulas or abscesses.
• Treatment: Treatment options include various surgical procedures, depending on the severity and individual case:
  • Excision: Surgical removal of the affected tissue and open wound healing.
  • EPSiT (Endoscopic Pilonidal Sinus Treatment): Minimally invasive technique for cleaning and removing the fistula tract using an endoscope.
  • Karydakis flap: Surgical procedure to remove the affected tissue and close the wound with a flap of adjacent tissue. Suitable for recurrent or complex cases.

Functional disorders

Functional disorders of the rectum include defecation disorders and fecal incontinence. These disorders are caused by structural or functional changes in the intestine.

Emptying disorders

• Difficulty emptying the bowels can be caused by slow-transit constipation, rectocele, or rectal prolapse, among other things.
• Symptoms: Difficulty passing stool, feeling of incomplete bowel emptying, problems holding stool, rectal prolapse
• Diagnostics: Diagnosing defecation disorders requires a thorough medical history and physical examination. Additional diagnostic procedures such as endoscopy, proctoscopy, magnetic resonance imaging with defecography, and transit time measurements may be necessary to identify the exact cause of the disorders.
• Treatment: Treatment options for defecation disorders include various conservative and surgical measures, depending on the underlying cause and severity of symptoms. These include dietary changes, pelvic floor training, medication, and rectal enemas. In selected cases, surgical treatment with procedures such as perineal rectal resection according to Altemeier, Delorme surgery, laparoscopic/robotic resection rectopexy, or laparoscopic/robotic ventral mesh rectopexy is advisable.

Fecal incontinence

• Fecal incontinence is a functional disorder that manifests itself in the form of uncontrolled wind or stool loss and can vary in severity. The causes of fecal incontinence are diverse and can be both functional and structural.
• Symptoms: involuntary loss of stool or gas
• Diagnostics: Diagnosing fecal incontinence requires a thorough medical history and physical examination, as well as proctoscopy. Additional procedures such as 3D endosonography, magnetic resonance imaging, or anomanometry may be necessary to determine the exact cause of the condition.
• Treatment: Initial treatment primarily involves intensive pelvic floor training for at least 6 months. Other conservative measures include dietary changes, biofeedback, and electrostimulation. If symptoms persist and conservative measures fail, surgical procedures such as sacral nerve stimulation and implantation of bulking agents (Sphinkeeper®) may be considered.