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All seven Medical Spheres ›Blood on the toilet paper, pain when passing stools, itching or a lump at the anus: such symptoms are common and often harmless, but not always. A proctology consultation clarifies the cause calmly and discusses what is right for you.
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Typical figures from the clinics and, for anal fissures, from the guideline. You will discuss your plan at the consultation.
Rectum and anus
Proctology deals with conditions of the rectum, the anal canal and the pelvic floor. Symptoms in this area are very common, but out of embarrassment people often keep quiet about them for a long time. Yet there is frequently a harmless cause behind them, and much can be eased without surgery. Common conditions include enlarged haemorrhoids, anal fissure, anal vein thrombosis and anal abscess, from which a fistula can develop.
The type of symptoms often gives a first clue. Stabbing pain when passing stools fits an anal fissure, a sudden, bluish lump at the edge of the anus fits an anal vein thrombosis, and throbbing, increasing pain with swelling points more to an abscess. Blood, itching, weeping, faecal soiling or involuntary loss of stool can have many causes. Only an examination brings certainty – all the more so with blood, because a serious condition such as bowel cancer can also be behind it.
An anal fissure is a narrow tear running lengthways in the sensitive skin of the anal canal, usually at the back. It is often preceded by hard stools. A cramped internal sphincter muscle is considered central: it reduces the blood supply, the tear heals poorly, and the pain makes the cramping worse. If a fissure does not heal within six to eight weeks, it is considered chronic; hardened edges and a small skin tag, the sentinel pile, often form at this stage. If it lies in an unusual position or there are several, doctors look for an underlying condition such as Crohn’s disease.
A fresh fissure often heals without a procedure. The basis is soft stools that pass without straining. An ointment that relaxes the sphincter muscle gives the tear time to heal over a few weeks, and a numbing ointment can ease the pain. A chronic fissure is usually treated in this way for six weeks first. If it does not heal, an injection that temporarily relaxes the muscle or a minor procedure, the fissurectomy, can be considered – according to the guideline, the first choice among surgical procedures. Partially cutting the internal sphincter muscle remains the exception because of the risk to continence, the ability to hold in stool and wind reliably.
The treatment
The consultation and examination usually already show where the symptoms are coming from. If bleeding remains unexplained, a colonoscopy follows.
Many symptoms improve with soft stools, suitable ointments and gentle care. A fresh anal fissure often heals this way, too.
If necessary, a procedure follows: from sclerotherapy or banding of enlarged haemorrhoids, through the prompt opening of an abscess, to surgery.
The path
Only the examination shows which treatment is right. Much can be resolved at the consultation; some things need a procedure.
Since when, how often, and when it hurts or bleeds: the symptoms are discussed without haste, as are previous illnesses and medication. No question is too intimate.
Inspection, gentle palpation and usually a proctoscopy, in which the anal canal is examined with a small instrument.
If bleeding from the rectum cannot be explained, a colonoscopy complements the examination to rule out causes further up the bowel.
Usually without a procedure at first: regulating bowel movements, ointments and skin care. If that does not help enough, a procedure is possible – as an outpatient or with a short stay, depending on the findings.
Follow-up appointments at the clinic accompany healing. Soft stools remain important afterwards too, to help prevent recurrence.
Statutory insurance or self-pay
Statutory health insurance
German statutory health insurance covers the consultation, examination and medically necessary treatment, up to and including surgery. For this, patients with statutory health insurance are treated at the Bürgerspital, the local hospital with a public healthcare mandate.
Appointments are available by arrangement, usually with a referral. With sudden severe pain, fever or heavy bleeding, go straight to an emergency department.
Private insurance or self-pay
For privately insured patients, too, medically necessary treatment is covered by their health insurance.
Besides the Bürgerspital, privately insured and self-pay patients can choose the Main-Tauber-Klinik, a private clinic embedded within the Bürgerspital. For self-pay patients, the costs depend on the findings and the treatment.
Specialists
In Wertheim, proctology is part of the Department of Surgery. Consultations, examinations and procedures are in the hands of the general and abdominal surgeons.
Locations
Each clinic shows on its own website how the treatment works there.
Germany
Patients with statutory insurance are treated at the Bürgerspital, a hospital with a public healthcare mandate; privately insured and self-pay patients can also go to the Main-Tauber-Klinik embedded within it. If needed, the colonoscopy is carried out by the gastroenterology department at the same address.
Frequently asked questions
When there is blood on the toilet paper or in the stool, passing stools is painful, there is itching or weeping, a lump can be felt or stool leaks involuntarily. Anything that has not improved after two to three weeks despite self-help is also a reason. Severe pain, fever or a lot of blood should be examined promptly.
As a rule, no, and many people find it less of an ordeal than they had feared. With a fresh fissure, however, the edge of the anus is very sensitive. A careful look is then often enough at first; the proctoscopy follows later or under anaesthetic.
Keep your stools soft: eat plenty of fibre, drink enough and keep active. Do not strain, do not sit on the toilet for long, and clean the anal area gently with water rather than with scented wipes. After a fissure, a high-fibre diet can also help prevent it from coming back.
The tear, together with its hardened edges and the sentinel pile, is cut away in a shallow layer, sparing the sphincter muscle. The wound is left open and heals from the inside over a few weeks; the tissue is examined under the microscope. Bleeding afterwards or inflammation can occur, and not every fissure heals the first time.
A blood clot in a small vein at the edge of the anus. It appears as a sudden, bluish and often very painful lump. Depending on how pronounced it is, ointment and painkillers are enough, or the clot is relieved with a minor procedure. An examination is the most reliable way to tell it apart from haemorrhoids.
Yes, haemorrhoids or a fissure are often behind it. But because blood can also point to a serious condition such as bowel cancer, any bleeding should be checked by a doctor once. If the cause remains unclear, a colonoscopy follows; an operation on the bowel would be a matter for bowel surgery.
Yes, if it is medically necessary – for patients with statutory and private insurance alike, from the examination to surgery. Patients with statutory insurance are treated at the Bürgerspital for this.
Further reading
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Reviews
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Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch bin rundum begeistert von meiner Erfahrung in dieser Haartransplantationsklinik. Von der ersten Kontaktaufnahme bis zur Nachsorge war alles hervorragend organisiert und professionell. Das gesamte Team war unglaublich freundlich, hilfsbereit und zuvorkommend. Man hat sich jederzeit gut aufgehoben und ernst genommen gefühlt. Besonders positiv fand ich, dass sich alle Mitarbeiter ausreichend Zeit genommen haben, um meine Fragen zu beantworten und jeden Schritt verständlich zu erklären. Auch der Service war erstklassig. Die Organisation, die Betreuung vor und nach dem Eingriff sowie die Kommunikation waren wirklich hervorragend. Das gesamte Team hat einen sehr kompetenten und gleichzeitig menschlichen Eindruck gemacht. Die Klinik selbst ist modern, sauber und sehr gut ausgestattet. Während der Behandlung wurde äußerst sorgfältig und professionell gearbeitet, und ich hatte zu jedem Zeitpunkt das Gefühl, in guten Händen zu sein. Ein großes Dankeschön an das gesamte Team für die tolle Betreuung und den freundlichen Umgang! Ich kann die Klinik absolut weiterempfehlen und bin mit meiner bisherigen Erfahrung sehr zufrieden. Wer Wert auf Professionalität, Qualität und einen hervorragenden Service legt, ist hier meiner Meinung nach bestens aufgehoben.
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanBisher war es nur ein Beratungsgespräch aber es war sehr gut.
Weight Doctors Group · Original in GermanIch fand, dass der Arzt gut und verständlich erklärt hat. Ich habe diese Woche noch einen Termin in einer anderen Klinik, da ich mich gründlich informieren möchte; auch der Preis wird dabei eine Rolle spielen – darüber bin ich ganz offen.
QUOLE Medisch Centrum · Original in GermanHervorragende Behandlung. Von der ersten Beratung bis zur Nachsorge hat mir Dr. Koch stets ein sehr gutes Gefühl vermittelt. Ich litt jahrelang unter einer echten Gynäkomastie, nach der OP kann sich das Ergebnis sehen lassen, mein Selbstbewusstsein ist endlich zurückgekehrt. Ich kann die Alster Klinik jedem empfehlen, der schon lange mit dem Gedanken spielt sich operieren zu lassen.
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Alster-Klinik Hamburg · Original in GermanÜber die ehrliche Einschätzung
Alster-Klinik Hamburg · Original in GermanIch habe mich sehr wohl geführt, das Gespräch war sehr gut, die Ärztin hat mir sehr ausführlich alles erklärt und bin mit einem sehr guten Gefühl nach Hause gegangen.
Westfalenklinik Fachklinik für Plastische und Ästhetische Chirurgie · Original in GermanIch bin eine sehr ängstliche Person. Bei Herrn Dr. Neis habe ich mich sofort wohlgefühlt. Behandlungsgespräche, Umgang, Freundlichkeit – es passt alles. Ich kann ihn ohne Bedenken und Einschränkung nur weiter empfehlen. Dankeschön Herr Dr. Neis für die tolle Arbeit.
CGCE Group · Original in GermanDr. Klarner ist sehr nett, hat mich sehr gut beraten und aufgeklärt. Ich hab mich gut aufgehoben gefühlt, vielen Dank!
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