Dott. Nando Gallese

There is great ignorance about anorectal diseases: all patients entering in a office of Proctology, are convinced they already know what they are affected and ask for the care they thought, helped by friends, old uncles, media, primarily Internet where you can easily find "everything and its opposite" and where it is dangerous to navigate between professionals sites and “far west” remedies, good and conclusive for all diseases. People come into the doctor’s office reciting a script standard, beginning with "Doctor, I suffer from hemorrhoids, fissures perhaps, and I want to be operated" (as if there was only one operation, or just what is in their brain): in my long career, I could see that most of the people, "have haemorrhoids into their heads and not where they should be" The more educated and informed patients, ask also a well-defined intervention, because conclusive, painless, etc. ..... I always answer that "it’s possible resolve only going to Lourdes", because the doctor just try to understand what is the illness, to be able to deal as best he can, but without any guarantee to achieve the desired result. The catchphrases continue with a "do not hurt me ..." at the time of the visit, as if it were the doctor and not the disease causing the pain. There will, therefore, a great deal of time explaining that "hemorrhoids are not a disease," that in the anus there are not only "hemorrhoids" and that those “who are well do not ask to be examined”. There are two other conditions that no one knows, but which are regularly reported:

1) the "constipation" - Everyone has his own idea (I’m constipated because I do not defecated every day, because I have hard stool, because "I strain very much", because in my family we’re all constipated, etc..)
Scientifically, there are specific criteria (Rome II criteria) to determine the presence and degree of constipation, but of course these must be investigated and evaluated by a specialist with particular experience in the field of procto-perineology, not by a general physician or general surgeon.....or by the patient himself or by his aunt ...! The diagnosis can be numerous and complex (obstructed defecation syndrome, Slow-transit, dyssynergia, organic constipation secondary to tumors, postsurgical adhesions, mega-dolicocolon, inflammatory stricture from Crohn’s, tuberculosis, sclerodermia, etc..) There are various possible combinations of therapies, from dietary, to pharmacological, surgical and rehabilitation. Often constipation is not, as you might think, a "cross" to bring to life: if you can recognize the causes, treatment may be medical and/or surgical: the choise of theraphy should be carefully evaluated with clinical and instrumental study.

2) The "colitis" (or irritable colon or spastic colitis, etc..) - Nobody knows what it is, even the doctor who diagnosed so casually, without performing any test, often attributing it to "anxiety or stress". The "irritable bowel syndrome (IBS)" involving the entire digestive tract and not just the last part (the colon). IBS is a "defeat" diagnostic, it is a "diagnosis of exclusion" that springs from the negativity of all possible (and essential) examinations performed (Colonoscopy, stool examination with search of parasites and their eggs, and test for intolerance to gluten and lactose) and by absence of malignant disease, diverticular desease, IBD (= Inflammmatory Bowel Disease like ulcerative colitis, Crohn’s disease, etc..). When the diagnostician do not understand anything ...... use the word "colitis". In the last 6000 years, from the time of the ancient Egyptians, surgeons have not changed their basic approach, calling "hemorrhoids" what protruding from the anus and practiced the systematic destruction of it by any means (knives, scissors, ligatures, hot irons ... then, recently, with electricity, ice, infrared ray, ultrasonic, radio frequency and then, miracle of miracles, the LASER: indeed is performed, with several destructive instruments, the same procedure, painful, naive, often useless, source of complications and recurrences, called hemorrhoidectomy ... "change the spoon ... but does not change the soup" The University and the principal scientific societies of Surgery, especially in Italy, have failed to "instruct" properly the disciples on the social and individual anal disease, because the traditions of "school" not provide specific training, rather, as it happened to me, with the utmost contempt for those diseases, considered "low rank", the first operation given to the young surgeon was that of "hemorrhoids" which involved "murder" of various, poor, anal appendages, with technique, more recently defined as ..... "Rottweiler Hemorrhoidectomy." For this reason if the surgeon not have the good fortune to know the real experts, his knowledge will be similar to those of his grandmothers, aunts and neighbors who know all about "hemorrhoids", "constipation" and "colitis", with best therapy based on a one of those miracle creams that really only do well for Pharmacists. A tip: do not get anal disease diagnosis alone, do not listen to friends who tell you to use cold water and ice, do not imitate the therapy of another person, because there is no one equal to another and there is no one who has the same disease with the same clinical expression. Everything that is wrong is also useless and potentially dangerous. Looking for a real expert: the proctologist. (For more details see "unitary theory of prolapse", "Starr0ne", etc.. www.nandogallese.com )