Proctology/ Anorectal Disorders


Millions of Americans suffer from hemorrhoids. There are multiple causes of hemorrhoids. Some common causes are: straining, prolonged constipation or diarrhea, pregnancy and childbirth, and prolonged sitting (including prolonged time sitting on the commode). Common symptoms of hemorrhoids include: bleeding with bowel movements, prolapse of hemorrhoids with bowel movements, pain and perianal itching. Hemorrhoids are classified into four (4) groups:

  • Grade I – bleeding
  • Grade II – protrusion with spontaneous reduction
  • Grade III – protrusion requiring manual reduction
  • Grade IV – protrusion of hemorrhoidal tissue that cannot be reduced

Determining the appropriate treatment of hemorrhoids is based upon several factors, including an individual’s health status and the grade of hemorrhoid(s). Conservative measures include: stool softeners, increasing fiber in the diet and/or adding a fiber supplement, drinking plenty of water and using sitz baths. There are several procedures that may be done in the office including rubber band ligation and sclerosis. Surgical options include: traditional hemorrhoidectomy, stapled hemorrhoidectomy, and suture ligation using Doppler.


Dr. Paonessa is trained in all aspects of hemorrhoid treatment and surgery. In fact, she is the co-editor of the second edition of the textbook The Surgical Treatment of Hemorrhoids. Call the office today for a consultation and get on the way to having your symptoms relieved.


Anal Fissure

An anal fissure is a tear or cut in the skin that lines the anal canal. The most common symptoms of an anal fissure are bleeding and rectal pain. Patients commonly describe this pain as “passing shards of glass”, or “passing razor blades”. The causes of anal fissure include: straining, constipation, diarrhea and/or any other factor that causes trauma to the anal canal. Most fissures can be managed conservatively with keeping the stools soft, adding a fiber supplement, sitz baths and topical medication prescribed by a physician. Anal fissures that do not heal with conservative medical management may need a surgery in the form of a partial internal sphincterotomy, which if performed correctly, does not alter bowel continence.

Call Dr. Paonessa today if you are experiencing any rectal pain or bleeding to obtain relief of your symptoms.

Acute and chronic fissure




Perianal/Perirectal Abscess

An abscess is a cavity or pocket filled with pus near the anus or rectum. Patients with an abscess usually experience a hard, painful lump in the anal or rectal area which may be surrounded by redness and which may be associated with fever or chills. A perianal/rectal abscess is usually caused by an acute infection/inflammation of the glands that line the anal canal. Occasionally, one of these glands becomes clogged/blocked and an infection results. Sometimes the abscess ruptures spontaneously but usually the abscess needs to be incised and drained. A majority of the time this can be performed in the office using a local anesthetic and provides the patient with immediate relief.

Anal Fistula

Sometimes when an abscess ruptures spontaneously or is opened surgically, a tunnel or tract forms between the infected gland in the anal canal and the skin outside the anus or rectum. This tunnel or tract is called an anal fistula. Approximately 50% of perianal/rectal abscesses will develop into an anal fistula. The opening on the outside of the skin is typically associated with some type of drainage, usually clear yellow, blood tinged, or thin brown in color. Most anal fistulas require surgery. There are a variety of surgical procedures, some of which are staged procedures, that may be performed based upon the type and complexity of the anal fistula. Dr. Paonessa is well trained to treat anal fistula and with excellent functional results for the patient.

Call Dr. Paonessa’s office today if you have a painful, swollen lump in the perianal/rectal area, if you suffer from recurrent perianal/rectal abscesses and/or you suffer from persistent perianal/rectal drainage.

Anal Absess Fistula

Disclaimer: Although this website may contain medical information, this is NO substitute for consulting with a physician. Self diagnosis by any patient is dangerous.

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