Anal complaints — bleeding, pain, itching, lumps, discharge — are among the most common reasons patients see a colorectal surgeon, and among the most postponed. Most conditions are benign and very treatable, often without conventional surgery. But bleeding should never simply be assumed to be haemorrhoids: the same symptom can signal something more serious, and a proper examination settles it quickly.

Haemorrhoids

Haemorrhoids are enlarged blood-vessel cushions in the anal canal, causing bleeding, prolapse (a lump that comes down), itching or discomfort. Treatment is stepwise:

Lifestyle and medical measures — fibre, fluids and toilet habits resolve many early haemorrhoids; ointments, suppositories and warm sitz baths ease symptoms while things settle.

Rubber band ligation — a quick, well-tolerated office procedure that treats most bleeding internal haemorrhoids without an operation.

Surgery — for large, prolapsing or recurrent haemorrhoids, our practice offers the full range of modern options, matched to your haemorrhoids rather than one-size-fits-all:

Laser haemorrhoidoplasty (LHP) — a 10–15 minute day procedure in which laser energy shrinks the haemorrhoid from within and seals its blood supply. No cuts, no stitches, and minimal risk of narrowing; most patients return to normal activity within days while the tissue continues shrinking over the following weeks.

Haemorrhoidal artery ligation (HAL/THD with recto-anal repair) — ultrasound guidance identifies the arteries feeding the haemorrhoids, which are stitched closed, and any prolapsing tissue is lifted and repaired. A day procedure with markedly less pain than excision; many patients are back at work within 2-3 days.

Conventional haemorrhoidectomy (Milligan-Morgan) — surgical removal remains the most effective option for very large, prolapsing haemorrhoids with external tags. It involves a longer recovery: regular pain relief and stool softeners for several weeks, and no heavy lifting for about six weeks.

We will recommend the least invasive option that will actually solve your problem.

Anal fissure

A fissure is a small tear in the anal lining causing sharp pain on passing stool — often described as “passing glass” — and bright bleeding. Most heal with stool softeners and relaxing ointments. Persistent fissures respond well to botulinum toxin injection, and chronic or complex fissures can be treated with reconstructive advancement flaps — approaches chosen deliberately to protect the sphincter muscles and continence.

Anal abscess and fistula

An abscess is an infected collection near the anus, needing prompt drainage. In up to a third of patients an abnormal tunnel — a fistula — remains between the bowel and the skin, causing recurrent discharge and infection. Fistula surgery is a special art: the aim is to cure the tunnel while preserving the sphincter muscles.

Honesty matters here: fistula surgery is difficult everywhere — even leading international units achieve permanent healing in roughly 70% of complex cases. That is exactly why accurate mapping and choosing the right technique for each fistula makes the difference.

Our practice uses 3D endoanal ultrasound and MRI— the gold standard for mapping fistulas and sphincter anatomy — to plan individualised, sphincter-preserving treatment. The full modern toolkit is available: seton placement (a soft drain that matures the tract, typically over about three months, before definitive repair), the LIFT procedure, advancement flaps, laser fistula closure (FiLaC), video-assisted treatment (VAAFT), platelet-rich plasma (PRP) injections, autologous fat-graft injections, and a peritoneal (abdominal) approach for rectovaginal fistulas — a comprehensive range of modern techniques under one roof, so treatment can be matched to your fistula rather than your fistula to a single technique.

Pilonidal disease

An infected sinus in the cleft between the buttocks, most common in young adult males. Treatment is matched to the disease: drainage for acute infection, minimally invasive techniques including laser ablation for suitable sinuses, definitive excision, and flap reconstruction for recurrent or complex disease.

Pruritus ani, skin tags, anal warts and anal cancer

Persistent anal itching, bothersome skin tags and anal warts (which need assessment and treatment) are all managed by the practice. Any persistent anal lump, ulcer or non-healing sore should be examined and, where needed, biopsied: anal cancer is uncommon and very treatable, but only when it is diagnosed rather than dismissed.

When bleeding is not “just haemorrhoids”

Rectal bleeding with pain, a change in bowel habit, weight loss, anaemia, or occurring from your mid-40s onward warrants a colonoscopy, not reassurance. Examination and, where needed, a scope, distinguish benign anal conditions from more serious causes — usually in a single visit.

To arrange an assessment, phone +27 21 201 6582.

These problems are our daily work; there is no need to be embarrassed, and no need to keep suffering.