Search Results (44)

Background/Objective: Anorectal disorders are a common yet underdiagnosed component of pelvic floor dysfunction, particularly among postpartum women. These conditions, including hemorrhoids, anal fissures, and fecal incontinence, are associated with physical discomfort and may negatively affect psychological well-being. Self-esteem has been identified as a potential mediator linking somatic symptoms to mental health outcomes, including depression. We aimed to assess the relationship between anorectal symptoms, self-esteem and the severity of depressive symptoms in a Polish population of postpartum women. Methods: A cross-sectional questionnaire-based study was conducted between June and December 2025, including 120 women aged >18 years, at least 3 months postpartum. Data were collected using online and paper questionnaires. The assessment tools included the Pelvic Floor Distress Inventory—Short Form 20 (PFDI-20), Rosenberg Self-Esteem Scale (RSES), and Beck Depression Inventory (BDI). Statistical analyses included the multiple regression model, logistic regression and Spearman’s rank correlation. Results: The most frequently reported anorectal symptoms included pain (45.83%), bleeding (42.5%), and pruritus (41.7%). The mean PFDI-20 score was 41.15 (SD 31.13). High self-esteem was observed in 55% of participants, whereas depressive symptoms were present in varying degrees of severity, ranging from no depressive symptoms (55.83%), mild (30%) to severe (0.83%). Significant positive correlations were found between pelvic floor dysfunction severity (particularly CRADI-8 and UDI-6 subscales) and depressive symptoms (BDI), while their correlation with self-esteem (RSES) was negative. The strongest positive correlation was observed between the overall PFDI-20 score and depression (r = 0.389). Multiple regression analyses identified anorectal symptoms, parity, hypothyroidism, and pre-pregnancy depression or anxiety as significant predictors of self-esteem. Anorectal symptoms and hormonal contraceptive use were significant predictors of depressive symptom severity. Among women who delivered vaginally, perineal tear was independently associated with greater depressive symptom severity (OR = 1.07, 95% CI: 1.01–1.14, p = 0.019). Conclusions: Postpartum anorectal and pelvic floor dysfunction symptoms are significantly associated with poorer psychological outcomes, including higher depressive symptoms and lower self-esteem. These findings highlight the importance of a multidisciplinary approach with routine psychological screening in postpartum care. Full article

PVP-stabilized silver nanoparticles (Ag NPs) were functionalized with sildenafil (Sil), leading to spherical NPs (Ag@Sil NPs) with a size of about 30 nm as observed through transmission electron microscopy and dynamic light scattering. Fourier-transformed IR spectroscopy confirmed the covering of the particles with Sil. The Ag@Sil NPs were incorporated into a 0.1 wt% ointment and tested for the treatment of acute anal fissures in a preliminary medical study involving 50 patients. Typical symptoms such as pain, bleeding, itching, and mass sensation were improved in the intervention group with no adverse effects. Molecular docking showed strong interactions with docking scores slightly above −10 kcal/mol between sildenafil and two different model complexes [Ag–Sil]⁺ for the Ag-bound sildenafil with either piperazine-N- or pyrazole-N-bound Ag⁺ ions and the muscarinic M2 and the nicotinic acetylcholine α3β4 receptor, which are both involved in anal sphincter regulation. All three showed superior binding compared with nitroglycerin and L-arginine. The residue analysis revealed a higher number of relevant interactions for the sildenafil and the two Ag⁺ complexes, compared to nitroglycerin and L-arginine, fully in line with the differences in the docking scores. Full article

Background and Objectives: Circular stapled hemorrhoidopexy (CSH) is a surgical method to treat patients with hemorrhoidal disease. Compared to conventional hemorrhoidectomy, it is associated with reduced postoperative pain and a shorter recovery time, supporting a quicker return to daily activities. However, in populations treated using this technique performed with first-generation staplers, a higher recurrence rate was observed. Ongoing advancements in stapler technology appear to improve the surgical outcomes of CSH, maintaining its previous advantages. The aim of this study is to compare the surgical outcomes and recovery process between CSH performed with the new-generation TST-36 stapling device (TS-CSH) and the Milligan–Morgan hemorrhoidectomy (MMH). Materials and Methods: Medical records of 48 patients with grade III or higher hemorrhoids treated electively with MMH (n = 24) or TS-CSH (n = 24) between January 2023 and January 2025 were retrospectively reviewed. MMH patients were matched by age, sex, and perioperative risk (American Society of Anesthesiologists Physical Status Classification System, ASA-PS). Those with a history of previous hemorrhoid surgery, fewer than two columns excised, ASA-PS III or higher, patients who underwent urgent surgery, or declining participation were excluded. During the follow-up period, ranging from 3 to 28 months, in the outpatient clinic, patients’ medical records were updated regarding postoperative recovery time, pain (NRS), analgesic use, urinary retention, defecation difficulties, bleeding, complications, satisfaction, and symptom recurrence. Demographic and perioperative data were collected from electronic records. Results: The TS-CSH group experienced significantly lower pain scores at first defecation (p = 0.003), 24 h (p = 0.016), and 7 days postoperatively (p < 0.001). Additionally, time to full recovery was significantly shorter following TS-CSH compared to MMH (14.0 vs. 30.0 days, p < 0.001). No cases of fecal incontinence and anal stenosis were recorded. Three patients were identified as presenting symptoms of recurrence, all in the TS-CSH group; however, this finding did not reach the threshold of statistical significance. Conclusions: CSH performed with the new generation of stapling devices is minimally invasive, feasible, and a safe technique for treating grade III or IV hemorrhoids. TS-CSH should be considered as an alternative to conventional hemorrhoidectomy, associated with a trend toward lower pain and faster return to daily activities while maintaining a comparable satisfaction rate. Full article

Background: Pelvic floor dysfunctions, congenital anomalies, and acquired defects of the female genital, urethral, and anal tract represent complex conditions requiring multidisciplinary management. This review synthesizes current evidence and aims to evaluate reconstructive surgical techniques, prosthetic use, and cosmetic approaches with a focus on functional and aesthetic outcomes. Methods: A structured literature search of PubMed, Embase, and the Cochrane Library was performed for the period from January 2000 to May 2025 (last search: 31 May 2025). Eligible studies included randomized controlled trials, prospective or retrospective clinical studies, and case series in English or Italian, enrolling women aged ≥18 years with a minimum follow-up of 6 months. Primary outcomes were anatomical restoration, continence, sexual function, and quality of life; secondary outcomes included patient satisfaction, wound complications, donor-site morbidity, and recurrence. Recent high-quality studies published after 2018 were prioritized to ensure an updated and evidence-based synthesis. Results: Out of 532 records, 94 full texts were assessed and 41 studies met the eligibility criteria, comprising a total of 1862 women. Flap-based reconstruction (gluteus maximus, VRAM, gracilis, ALT) remained the cornerstone for large or irradiated defects, while prosthetic meshes improved anatomical outcomes but raised concerns of erosion and chronic pain, leading to a shift toward autologous tissue. Cosmetic gynecology procedures (labiaplasty, vaginoplasty, perineoplasty) showed high patient satisfaction, although the evidence was limited and heterogeneous. Across studies, improvements were observed in continence, sexual function, quality of life, and self-image when reconstructive and aesthetic principles were integrated. Conclusions: Reconstructive and cosmetic pelvic surgery significantly impacts functional recovery and psychological well-being. Standardized outcome reporting, prospective multicenter trials, and the integration of plastic surgery, physiotherapy, and psychological support are needed to optimize patient-centered care. The findings highlight the growing role of personalized surgical planning, with reconstructive decisions increasingly guided by patient-specific anatomy, functional goals, and validated patient-reported outcome measures. Full article

Introduction: Chronic Idiopathic Constipation (CIC) is a common pediatric gastrointestinal disorder (GI) characterized by persistent difficulty in defecation, with no identifiable underlying cause. Although most patients are successfully treated with medical therapies, surgical intervention is often needed for refractory disease. We evaluated the impact of Antegrade Continence Enemas (ACE) and Botulinum Toxin (BT) injection to the internal anal sphincter on laxative use, symptom resolution, and healthcare utilization. Methods: A retrospective chart review was conducted to identify patients ≤ 18 years old presenting to a pediatric surgery clinic with a chief complaint of CIC between 1 March 2014 and 1 March 2024. Patients meeting the Rome IV criteria for idiopathic constipation and fecal incontinence were included. Surgical procedures were categorized into BT injection or ACE channel creation. The primary outcome was change in daily oral laxative use at 1 year, and secondary outcomes included symptom resolution and CIC-healthcare utilization at 1 year postoperatively. Results: Of the 125 children who presented with CIC, 47 (37.6%) underwent surgery. Mean age was 6 years at the time of surgery. 17 (36.2%) had ACE channel creation, while 30 (63.8%) received BT injections. At 1 year, daily oral laxative polypharmacy decreased from 60.2% to 41.0%, p < 0.001, with a greater reduction in ACE than BT (adjusted mean difference: −1.05, 95% CI: −1.75 to 0.34, p = 0.004) after adjusting for demographics and baseline clinical factors. Overall, symptom resolution of encopresis (79.1% to 39.5%, p = 0.001), abdominal pain (88.4% to 27.9%, p < 0.001), and abdominal distension (67.4% to 27.9%, p < 0.001) was observed with no significant difference between groups at 1 year. ACE patients had significantly more postoperative outpatient CIC-related visits and no change in ED visits compared to fewer visits in BT patients. Conclusions: Both ACE and BT recipients had improvements in constipation-related symptoms and laxative use. However, ACE resulted in a significantly greater reduction in daily laxative use and more postoperative CIC-healthcare visits than BT alone. Full article

Background: Infectious proctitis remains an underrecognized entity, although sexually transmitted diseases, especially bacterial infections, exhibit a marked increase in their incidence. Methods: Here, we report a case of a 44-year-old man who presented to the emergency department with lower abdominal and rectal pain, tenesmus, fever and night sweats for the past 6 days. Results: The computed tomography initially revealed a high suspicion of metastatic rectal cancer. The endoscopic findings showed a 5 cm rectal mass, suggestive of malignancy. The histologic examination showed, however, no signs of malignancy and lacked the classical features of an inflammatory bowel disease, so an infectious proctitis was further suspected. The patient reported to have had unprotected receptive anal intercourse, was tested positive for Treponema pallidum serology and received three doses of intramuscular benzathine penicillin G. A control rectosigmoidoscopy, imaging at 3 months and histological evaluation after antibiotic treatment showed a complete resolution of inflammation. Conclusions: Syphilitic proctitis may mimic various conditions such as rectal cancer or inflammatory bowel disease and requires a high degree of suspicion. Clinicians need to be aware of infectious proctitis in high-risk populations, while an appropriate thorough medical history may guide the initial diagnostic steps. Full article

Background: Cytomegalovirus (CMV) colitis is commonly seen in patients who are immunodeficient or have inflammatory bowel disease. Among the gastrointestinal sites affected by CMV, the colon is the most frequently affected, though rectal involvement is relatively rare. Reactivated CMV proctitis primarily occurs in elderly patients with comorbidities and is quite uncommon in immunocompetent individuals. Patients with reactivated CMV typically present with symptoms such as diarrhea, hematochezia, or tenesmus. Case presentation: We report a case of a female patient with uncontrolled diabetes who presented to the clinic complaining of perianal pain. She had no history of diarrhea or rectal bleeding. Lower GI endoscopy reported a small, localized, approximately 0.5 cm swelling in the proximal anal canal in addition to sigmoid diverticulosis. The biopsy revealed a small ulcer at the anorectal junction caused by CMV and confirmed by immunohistochemistry. Unfortunately, the patient was lost to follow-up before antiviral therapy could be initiated. Conclusions: This case highlights an uncommon presentation of reactivated CMV proctitis in an older diabetic patient presenting solely with perianal pain. Clinicians should maintain a high index of suspicion for CMV infection in elderly patients with comorbidities, even when classical colitis symptoms are absent, to avoid delayed diagnosis and management. Full article

Background/Objectives: Chronic anal fissure, an anorectal condition, is characterized by internal anal sphincter fibers at the base of the fissure. The lifetime prevalence is 7–8%. Medical management and lifestyle modifications are the first-line treatments, whereas chemical or surgical internal anal sphincterectomy is an option for refractory cases. The aim of this study was to evaluate the impact of surgical anal canal length and sphincter pressure on postoperative symptom relief and continence outcomes. Methods: A total of 26 patients diagnosed with chronic anal fissures were selected for surgical treatment. Five patients voluntarily withdrew, leaving 21 cases for analysis. In patients undergoing open lateral internal sphincterotomy, anal canal length and sphincter pressure were assessed preoperatively and three months postoperatively using endoanal ultrasonography and high-resolution anal manometry. Results: Postoperatively, all patients experienced complete resolution of pain and bleeding. The expected decrease in resting pressure was not significantly associated with sex. A significant weight gain was observed postoperatively (p = 0.001). Although a significant decrease was observed in preoperative sphincter resting pressure and VAS scores, Wexner scores remained unchanged. Preoperatively and postoperatively, mean sphincter pressure was significantly lower in the spontaneous vaginal delivery group than that in the non-spontaneous vaginal delivery group (p < 0.05). Patients with short anal canal lengths had greater pressures reductions, though not statistically significant. Conclusions: Lateral internal sphincterotomy is an effective and safe treatment for chronic anal fistula when performed by experienced surgeons. Anal canal length may influence postoperative complications and surgical decisions. Larger studies are needed to confirm these findings. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Background: “Chemsex” involves the intake of a range of drugs (e.g., synthetic cathinones, gamma-hydroxybutyric acid/gamma-butyrolactone (GHB/GBL), ketamine, methamphetamine, “poppers”, type V phosphodiesterase (PDE) inhibitors, MDMA/ecstasy, cocaine, cannabis, and occasionally a few other molecules as well, to enhance and prolong sexual experiences. This paper aims to provide an overview of the clinical pharmacology of the vast range of drugs that are being used for chemsex with a focus on both the medical and psychopathological disturbances that they can produce. Methods: A narrative literature review was conducted using Pubmed, Scopus, and Web of Science databases. A total of 273 papers published up to January 2025 were screened; articles were selected based on relevance to chemsex/sexualized used behaviour and related substances. Both human and preclinical studies were considered. Results: The use of stimulants is likely related to the need to increase as much as possible both sexual arousal and performance but also to increase social interactions. Furthermore, the empathogenic/entactogenic activities of some MDMA-like “love drugs” facilitate the occurrence of “feeling closer/more intimate” emotional sensations, and GHB/GBL may provide the user with a subjective sensation of disinhibition, hence facilitating condomless meetings with a higher number of random partners. Conversely, ketamine may be used to both enjoy its psychotropic dissociative characteristics and facilitate the potentially painful receptive anal intercourse and/or fisting experiences. Most typically, these drugs are consumed in combination, with polydrug exposure possibly facilitating the occurrence of serotonergic syndrome, seizures, drug–drug pharmacokinetics’ interaction, and sympathomimetic overstimulation. Following these polydrug exposures, a range of psychopathological conditions have at times been reported. These issues may lead to misuse of opiates/opioids, gabapentinoids, and/or antipsychotics. Conclusions: Further actions should aim at reducing the stigma that prevents individuals from accessing necessary healthcare and support services. A multidisciplinary approach that combines medical, psychological, and social support remains key to managing the complex challenges posed by chemsex-related drug use. Full article

Interstitial cells of Cajal (ICCs) play a key role in gastrointestinal smooth muscle contractions, but their relationship with anal canal function in advanced haemorrhoidal disease (HD) remains poorly understood. This study uses deep neural network (DNN) models to estimate ICC presence and quantity in anal canal tissues affected by HD. Haemorrhoidectomy specimens were collected from patients undergoing surgery with the LigaSure device. A YOLOv11-based machine learning model, trained on 376 immunohistochemical images, automated ICC detection using the CD117 marker, achieving a mean average precision (mAP50) of 92%, with a recall of 86% and precision of 88%. The DNN model accurately identified ICCs in whole-slide images, revealing that one-third of grade III HD patients and 60% of grade IV HD patients had a high ICC density. Preoperatively, pain was reported in 35% of grade III HD patients and 41% of grade IV patients, with a significant reduction following surgery. A significant decrease in bleeding (p < 0.0001) was also noted postoperatively. Notably, patients with postoperative bleeding, diagnosed with stage IV HD, had high ICC density in their anorectal tissues (p = 0.0041), suggesting a potential link between ICC density and HD severity. This AI-driven model, alongside clinical data, may enhance outcome prediction and provide insights into HD pathophysiology. Full article

Bowel endometriosis is a complex condition predominantly impacting women in their reproductive years, which may lead to chronic pain, gastrointestinal symptoms, and infertility. This review highlights current approaches to the diagnosis and management of bowel endometriosis, emphasizing a multidisciplinary strategy. Diagnostic methods include detailed patient history, physical examination, and imaging techniques like transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), which aid in preoperative planning. Management options range from hormonal therapies for symptom relief to minimally invasive surgical techniques. Surgical interventions, categorized as shaving excision, disc excision, or segmental resection, depend on factors such as lesion size, location, and depth. Shaving excision is preferred for its minimal invasiveness and lower complication rates, while segmental resection is reserved for severe cases. This review also explores nerve-sparing strategies to reduce surgical morbidity, particularly for deep infiltrative cases close to the rectal bulb, anal verge, and rectosigmoid colon. A structured, evidence-based approach is recommended, prioritizing conservative surgery to avoid complications and preserve fertility as much as possible. Comprehensive management of bowel endometriosis requires expertise from both gynecologic and gastrointestinal specialists, aiming to improve patient outcomes while minimizing long-term morbidity. Full article

Background and Clinical Significance: Retrorectal cystic hamartomas (“Tailgut cysts”) are rare developmental cysts that appear in the retrorectal space, arising from aberrant remnants of the post-anal primitive gut in case of an incomplete embryogenetic involution. Case Presentation: We present the case of a 30-year-old woman with a history of chronic lower abdominal pain. Other digestive symptoms, like rectal fullness, constipation, pain on defecation, rectal bleeding or genitourinary obstruction symptoms, were not associated. During a period of 3 years, she underwent several surgical procedures for ovarian cysts, without relieving the symptomatology. A computed tomography (CT) scan showed a presacral tumor with a right pararectal development. A surgical resection of the lesion using an anterior approach was performed, with the final pathological diagnosis of a retrorectal cystic hamartoma (“tailgut cyst”). Conclusions: This case underlines the fact that retrorectal masses can be challenging to diagnose, and tailgut cysts must be taken into consideration in cases of perirectal tumors in patients with a history of multiple failed procedures and surgeries. Full article

Background and Objectives: The selection of an appropriate anesthesia method is a critical factor in the surgical treatment of proctological diseases, significantly impacting patient outcomes and comfort. Pudendal nerve block (PNB) and spinal anesthesia (SA) are commonly employed in these surgeries, yet the optimal choice between the two remains debated. This study aims to compare the efficacy and safety of PNB and SA in patients undergoing surgical treatment for various proctological conditions, with a focus on postoperative pain management, functional outcomes, and complication rates. Materials and Methods: A prospective observational study was conducted on 590 patients who underwent proctological surgery under either PNB (n = 435) or SA (n = 155). Pain levels were assessed using the Visual Analog Scale (VAS), while functional outcomes were measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0). Statistical analysis was performed to compare the outcomes between the two groups. Results: Patients in the PNB group reported significantly lower postoperative VAS scores compared to those in the SA group, particularly in hemorrhoidectomy and laser hemorrhoidoplasty procedures. The PNB group also demonstrated superior functional outcomes, with lower postoperative WHODAS 2.0 scores and a reduced incidence of urinary retention compared to the SA group. Furthermore, the duration of surgery and hospital stay were significantly shorter for patients in the PNB group. Conclusions: The findings suggest that PNB may offer advantages over SA in proctological surgeries, particularly in terms of pain management, functional recovery, and reduced complication rates. PNB should be considered a viable alternative to SA, particularly in cases where rapid recovery and minimizing complications are priorities. Exceptions to this include specific proctological surgeries, such as those for malignant tumors in the region, complex anal fistulas, proctological conditions arising from inflammatory bowel diseases, and patients on immunosuppressive therapy. Further research is needed to confirm these results and optimize anesthesia selection in this context. Full article

Anal fistula, characterized by abnormal tracts between the perianal skin and the anal canal, presents challenges in treatment because of its diversity and complexity. This study investigates the use of non-thermal plasma as a postsurgical therapy for anal fistula, aiming to promote healing and tissue regeneration. A specialized plasma reactor was designed to apply non-thermal plasma within the anorectal cavity practically. Non-thermal plasma treatment was administered to 20 patients including 10 undergoing fistulectomies and 10 undergoing fistulotomies. The average duration of non-thermal plasma application in the operating room was shorter for fistulotomies. The pain reported the day after surgery was similar in both groups. Improvements in the number of evacuations starting from the day after surgery, as well as the assessment of stool quality using the Bristol scale, indicated satisfactory intestinal recovery. Fistulotomy patients exhibited faster wound healing times. These findings underscore the efficacy of non-thermal plasma as a postoperative therapy for anal fistula, enhancing healing and recovery outcomes without increasing complication risks. Full article