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Friday, March 7, 2014
Anal dilation/surgery for the elderly
What are the risks of anal dilation and/or hemorrhoidectomy for an 86 year old woman who has dementia? A recent colonoscopy revealed diverticulosis and hemorrhoids. She also has some prolapse. She has treated anal discomfort for years with creams, stool softeners and sitz baths. She now experiences indeterminate pain after BM`s and throughout the day. Sometimes, though, her expressed pain seems more related to the confusion and anxiety of her dementia. Her post-op care will be difficult because she will experience post-op pain that will be (to her) indistinguishable from the pain she feels now. Are there alternative treatments other than the usual remedies mentioned above, or will surgery improve her life?
There are many remedies to treat an anal fissure, short of surgery or dilation. Medicated suppositories, stool softeners, fiber, laxatives, anal nitroglycerine for pain, even Botox. That being said, surgery is very effective in the majority of patients. Of course the risk is fecal incontinence of some degree.
Janice Frederick Rafferty, MD
Professor of Surgery
Chief of Colorectal Surgery Division
College of Medicine
University of Cincinnati