By Dr. Bui Trung

Do you have painful bowel movements? Do you feel tenderness and pain down the “valley” when you are comfortably sitting in front of your computer and this pain won’t go away? Do you wake up in the middle of the night with itching and pain, a literal pain in the ass?

The likelihood is that you have a problem that many people feel uncomfortable or even ashamed to talk about. However, rest assured, your proctologist or visceral surgeon has heard it all before and you should seek medical advice and talk to him or her about your problems.

Around 10% of the population experience discomfort and sometimes-excruciating pain in the anal region, which can be due to several problems.

You may suffer from anal fissures, which are similar to having a paper cut in the lining of your anus. Since fissures are caused by constipation and straining when you try to “go”, the best treatment is to change the types of food you consume and increase your fiber and water intake. This is especially important in a tropical climate such as Việt Nam. You may also take fiber supplements, which you be purchased in any pharmacy, to soften your stool. If your fissure(s) is painful, consult a doctor who can prescribe topical treatment. In some cases, surgery may be recommended to ensure the fissure(s) does not become infected and heals properly.

Another possibility is that you may suffer from external hemorrhoids. Hemorrhoids are actually present in all individuals; they are blood vessel “cushions” located at the opening of your anal canal and the lower rectum. There is an ample blood supply down there, and when you strain, the hemorrhoids, also called “piles”, can enlarge and protrude, causing itching, bleeding and discomfort. The blood in a vessel can also clot, forming a thrombus, which is very painful.

The good news is that most hemorrhoids dissolve on their own. For uncomplicated hemorrhoids, hot water baths, topical ointments and painkillers such as Paracetamol can ease the symptoms. You should also consider avoiding spicy and constipating foods, eat lots of fruits and vegetables and drink plenty of water.

However, sometimes surgery is the only option, especially with grade 3-4 hemorrhoids, when they have become so enlarged that they cannot be pushed back and cause not only pain but also severe risk of thrombosis and bleeding.

Finally, if your pain does not allow you to sit properly, wakes you up at night and is also accompanied by fever, you may be suffering from either a peri-rectal or peri-anal abscess, generally referred to as an anal abscess. Anal abscesses should be treated urgently with antibiotics and surgery in order to externally drain them. A delay in treatment may cause serious worsening of the condition and unnecessary complications. If an anal abscess is not drained, it may find a way to create small tunnels in the tissue surrounding the anus creating what we refer to as anal fistula. If you have already developed an anal fistula, more complex investigations, such as a CT scan or “fistulogram”, are necessary to investigate where the tunnels start and where they end, and surgery will be required to resolve the problem and prevent reoccurrence.

Several diseases and conditions can also cause the development of an anal fistula, and it is therefore  important for your doctor to perform a proper examination and review your medical history. It may be necessary to perform additional tests to identify the true cause of the problem and to ensure you receive appropriate treatment.— L’Hôpital Français de Hanoi

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*Dr. Bui Trung is a Visceral and Digestive surgeon with over 30 years of experience in complex disease management and treatment.

After extensive training in Việt Nam and France, he has brought his extensive knowledge to the L’Hôpital Français de Hanoi where he successfully established the department of Visceral Surgery.

He works with his French colleague Dr. Bernard Guillaume and a multidisciplinary team of gastroenterologists and other specialists to provide high quality holistic care to all his patients.

The team is available 24/7 for routine and emergency care to all patients. If you have any questions or want to book an appointment with our doctors, please contact us at our phone number 84 – 24.3577.1100, or email us at contact@hfh.com.vn