Conditions We Treat

Anal Abscess

An anal abscess occurs when an anal gland becomes obstructed, causing pus to accumulate in the subcutaneous tissue. This results in pain, swelling, and sometimes drainage at the infected area. You might also feel feverish or fatigued as your body fights off the infection. Typically, the abscess is drained in the office so the infection can clear. Antibiotics are used in some cases but are generally not adequate to treat anal abscesses.

Anal Fissure

An anal fissure occurs when a small tear is formed in the anal lining or perianal skin. Approximately 235,000 new cases occur in the United States every year. They can be caused by trauma to the anal area from passing large stools, constipation, while wiping, or during childbirth. Symptoms include sharp pain with bowel movements, bright red blood on the toilet tissue, and an itching sensation around the anus. Most fissures will heal with topical ointments. When topical treatments are not effective, injecting Botox into the internal anal sphincter can be curative. Rarely surgery is required to treat a fissure.

Anal Pain

Pain around the anus is very common and has a variety of causes. While many causes of anal pain are harmless, rarely, anal pain can be indicative of a serious condition that requires urgent treatment. Anal pain that is accompanied by bleeding, that worsens, or is accompanied by a fever or chills should be evaluated by a health care provider. Anal pain that is ongoing should also be evaluated.

Colitis

Colitis refers to inflammation of the large intestine. There can be a variety of causes for colitis, including bacterial infections or inflammatory bowel disease. Colitis is often accompanied by a variety of symptoms, usually severe cramp-like pains, fever, and diarrhea with or without blood. Some types of colitis can resolve on its own, but most of the conditions causing colitis require medical treatment.

Diarrhea

Diarrhea is characterized by loose, watery stools that occur three or more times a day. Acute diarrhea goes away after a day or two. If diarrhea lasts longer than a few days, it may be a sign of an underlying problem and should be evaluated by a health care provider. Diarrhea can be caused by bacteria, viruses, parasites, medication, food sensitivities or intolerances, or diseases that affect the colon, small intestines or stomach.

Hemorrhoids

Hemorrhoids are blood vessels located in the wall of the anus and rectum that play an important role during bowel movements. Everyone has some degree of hemorrhoidal tissue, however hemorrhoids become a problem if they are too large, swollen or inflamed. A low fiber diet, prolonged sitting on the toilet, diarrhea, and straining during exercise are can increase your risk for developing symptoms like bleeding, itch, pain, and inflammation. Depending on the location and degree of symptoms. hemorrhoids can be treated with suppositories, creams, minor in-office procedures, or surgery.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic group of symptoms including pain in the abdomen, and changes in bowel movements such as diarrhea, constipation, or both. There is no visible sign of disease or damage in the digestive tract with IBS. Risk factors for IBS include having a family member with IBS, history of stressful or difficult life events, and having a past severe infection in the digestive tract. To diagnose IBS, health care providers look for a pattern in symptoms and will do a variety of tests to rule out other possible causes for symptoms.

HIV-prevention & PrEP

Your health care provider can help you determine how you can best reduce your risk. Certain medications, when taken correctly, can help prevent HIV. PrEP (pre-exposure prophylaxs) is a once-daily pill that prevents HIV infection for people who are at risk. Patients on PrEP must meet with a health care provider every three months for testing and to renew their prescription. PEP (post-exposure prophylaxis) is daily medication taken shortly after potential exposure to HIV (such as through sex). A course of PEP lasts 28 days and is most effective if taken very shortly after exposure. The New York State Department of Health recommends that PEP should be started no later than 36 hours after exposure to HIV. If you think you need PEP, please get immediate care, either at our office, the department of health or at an emergency room. With PEP, timeliness is crucial.

Sexually Transmitted Infections

Sexually transmitted infections (STIs) are infections which can be passed from one person to another through sexual contact and are caused by bacteria, viruses, and parasites. Gonorrhea, Chlamydia, syphilis, and Human Immunodeficiency Virus (HIV) are passed through sexual contact including oral, anal, vaginal intercourse, or exposure to bodily fluids. Human papillomavirus (HPV), and herpes virus can be spread through skin-to-skin or sexual contact. Antibiotics treat STIs caused by parasites and bacteria, while viral STIs which cannot be cured are managed with medications. HIV and Syphilis are diagnosed through bloodwork. Gonorrhea and Chlamydia are diagnosed with urine, throat, genital, and/or rectal swabs (each location where you are exposed should be tested). Herpes and human papillomavirus are typically diagnosed only if symptoms are present.

Anal Cancer

At Lasery Surgery Care of New York patients throughout New York can receive treatment for a variety of conditions which affect the Fecal Incontinence. Anal cancer accounts for 2.5% of digestive cancers in the United States and the incidence is rising. Anal cancer usually has little symptoms in early stages, but can cause bleeding, itching, pain, changes in bowel movements, or lumps in the anal area. Anal cancer is more common in women than men, and usually occurs in older adults. Women with cervical dysplasia, men who have sex with men, those who are immunocompromised, including people living with HIV have a higher risk for developing anal cancer compared to the general population. Found early, anal cancer is highly treatable.    Special screening exams can be used to test for precancerous lesions (called “HSIL”). Treating HSIL has been shown to reduce the risk of developing cancer.

Anal Fistula

A fistula is an abnormal tract that connects a primary opening inside the anal canal to another opening on the skin near the anus. Anal fistulas often occur in association with an abscess. The external opening of the fistula may appear red and inflamed and can leak pus and blood. Fistulas are treated with surgery that is usually performed in the office. More complicated fistulas may require multi-stages procedures.

Anal Warts

Anal warts (a.k.a. condyloma) are caused by the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection, and nearly all sexually active individuals have been exposed to HPV. Most people will experience no symptoms; however, some people with will develop warts inside or outside or their anus. Anal warts can cause itching, bleeding, or sometimes go unnoticed. There are multiple ways we can treat anal warts, depending on the severity of the condition and preference of the individual.

Constipation

Constipation refers to bowel movements that are difficult to pass or that occur less than once every three days. Characteristics of constipation include dry and hard stools, painful bowel movements, and having the feeling that you have not fully emptied your bowels. Constipation is very common among people of all ages. However, some factors can make people more likely to suffer from constipation such as older age, pregnancy and childbirth, not consuming enough fiber, certain medications, and specific neurological or gastrointestinal disorders. Constipation can predispose you to other issues such as painful hemorrhoids, anal fissures, fecal impaction, and strain to the pelvic floor muscles.

Fecal Incontinence

Fecal incontinence is the loss of bowel control. This leads to an unexpected passing of stool or gas. There are many causes of this condition including chronic constipation, watery stools, fecal impaction, long-term laxative use, surgery, injury to anal muscles, nerve damage, hemorrhoids or rectal prolapse, or stress.

Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic skin disease that causes painful, boil-like lumps under the skin. The lumps can become inflamed and painful, and often break open, causing abscesses that drain fluid and pus. HS is caused by blockages of the hair follicles, which trap bacteria and lead to inflammation.

Pilonidal Disease

Pilonidal disease is an inflammatory condition involving the hair follicles along the crease between the buttocks. This can present itself in several ways: a pilonidal abscess in which the follicle becomes infected and pus collects, a pilonidal cyst in which a hole or cyst forms when there has been a prolonged abscess, a pilonidal sinus in which a tract forms from the hair follicle either under the skin or deeper beneath the surface, or a small pit or pore in the skin that contains dark spots or hair. Symptoms of pilonidal disease includes pus drainage, tenderness over the area after prolonged sitting or being active, fever, or a warm, tender, swollen spot by the tailbone. Pilonidal abscesses must be drained by a health care provider. Pilonidal disease is typically treated surgically.

Rectal Bleeding

Rectal bleeding is defined as the passage of blood from the anus. The blood can be mixed with stool, mucus and/or blood clots. Rectal bleeding can be caused by a variety of conditions such as hemorrhoids, anal fissures, proctitis, Crohn’s disease, diverticulosis, ulcerative colitis, rectal ulcer, rectal prolapse, anal cancer, and colon cancer.

Pelvic Floor Dysfunction/ Levator Ani Syndrome

Pelvic floor dysfunction occurs when the muscles of the pelvic floor spasm. These muscles support the bladder, urethra, and rectum. Levator Ani Syndrome is a specific kind of pelvic floor dysfunction in which the levator ani muscle, found near the anus, spasms and causes rectal pain. Symptoms of levator ani syndrome include rectal pain not associated with bowel movements, constipation, problems passing bowel movements, bloating, needing to urinate often without being able to control the flow, bladder pain, and urinary incontinence. The exact cause of levator ani syndrome is unknown. There are many available treatment options to help manage the symptoms of pelvic floor dysfunction.

Treatments We Offer

Digital Anorectal Examination

A healthcare provider may use a small tube with a light, called an anoscope, to examine your anus and the lower part of your rectum. This is done to assess diseases of the rectum and anus including hemorrhoids, fissures, warts, proctitis, and certain infections.

Anal Pap Test/HPV Screening

High resolution anoscopy (HRA) uses a special microscope to find abnormal areas of the anus and lower rectum. A lubricated plastic anoscope is inserted into the anus. Then, a piece of gauze moistened with acetic acid (vinegar) is placed to allow abnormal lesions to be visualized. The health care provider reinserts the anoscope and uses a colposcope (a machine with a light source and high definition magnifying lenses) to examine the from the perianal area to the distal rectum. Iodine is also used to help define potentially abnormal lesions. If abnormal areas are seen, the provider may take small biopsy (These are very superficial and about the size of a sesame seed that sent to the pathologist for evaulation).

Treatment of Condyloma (Anogenital Warts)

Anal and genital warts can be treated with topical creams or surgical therapy. Topical therapy involves application of the medication to the affected area over the course of several months. When topical therapy is not the best option, the lesions can be treated surgically. For patients with very few lesions, the treatment can be performed in the office with only a local anesthetic. When patients have more extensive disease, sedation is administered by our anesthesiologist. Unlike most other surgeons, we use high resolution anoscopy during the procedure, allowing us to precisely target the treatment. We can more effectively treat the lesions and avoid unnecessary trauma to normal tissue. In most cases, we can eliminate all warts in a single session. Recurrence is possible. We will discuss measures you can take to reduce the likelihood that warts will resurface.

Treatment of HSIL (Anal Precancerous Lesions)

There are several treatment options for anal high grade squamous intraepithelial lesions (HSIL). Electrocautery ablation is usually the treatment of choice because it allows us to precisely target the lesions and it is associated with lower recurrence rates than the other available options. If you are diagnosed with anal HSIL, we will discuss the best treatment and surveillance plan for you.

Treatment of Perianal Abscess

If an anal abscess is very small, it may be treated with warm baths and antibiotics. However, most abscesses require drainage. This is usually accomplished in the office with local anesthetic. Once the area is anesthetized, a small incision is created over the abscess and the fluid is drained. Patients experience immediate relief of their symptoms once the drainage is performed.

Rubber Band Ligation for Internal Hemorrhoids

Rubber band ligation is an option for some internal hemorrhoids that remain symptomatic despite topical therapy and changes in lifestyle. If the hemorrhoid originates above the level of pain fibers, it can be ligated with a rubber band. This procedure is usually relatively painless and is performed while the patient is awake in our office.

Sphincterotomy for Anal Fissure

Sphincterotomy is a procedure for patients with chronic, non-healing anal fissures, although almost all patients will heal with less invasive treatments. Sphincterotomy is performed in the surgery center and patients go home the same day. While the patient is under sedation, a small incision is created at the anal verge and the internal sphincter muscle is partially divided. This helps the fissure heal by preventing anal spasms.

PrEP/PEP Prescriptions

Your health care provider can help you determine how you can best reduce your risk. Certain medications, when taken correctly, can help prevent HIV. PrEP (pre-exposure prophylaxis) is a once-daily pill that reduces risk of HIV infection by approximately 99% for people who are at risk. You should be seen by a health care provider to determine if PrEP is right for you, and to have necessary lab work completed, including blood testing. Patients on PrEP must meet with a health care provider every three months for bloodwork, and to renew their prescription. PEP (post-exposure prophylaxis) is daily medication taken shortly after potential exposure to HIV (such as through sex without a condom). A course of PEP lasts 28 days and is most effective if taken immediately after exposure. The New York State Department of Health recommends that PEP should be started no later than 36 hours after exposure to HIV and the sooner the better. If exposed to HIV you should contact a health care provider right away to see if PEP is right for you

Anorectal Manometry

Anorectal manometry measures the resting, squeeze, and straining pressures in the anal canal, and allows us to evaluate rectal sensation. We can also make sure normal anorectal reflexes are present. This test is done in the office and takes less than ten minutes to complete. It gives us useful information for patients with fissures, constipation and incontinence.

Solesta ® for Fecal Incontinence

Solesta® — a gel composed of two naturally occurring materials- dextranomer and hyaluronic acid (HA) – is administered by your doctor to improve the bulk and thickness of the anal walls. This is a quick, nonsurgical approach and the HA in Solesta has been used in more than 40 million procedures worldwide, often as a dermal filler for wrinkle correction.

Solesta has been proven to significantly reduce accidents and help patients achieve a better quality of life.  Studies have shown that Solesta can help patients return to a more active lifestyle (socializing, going to work, etc.), and reduce overall depression and embarrassment associated with their bowel control problems. Solesta is indicated for the treatment of fecal incontinence in patients 18 years and older who have failed conservative therapy (e.g. diet, fiber therapy, anti-motility medications).

Anal Fissure

An anal fissure occurs when a small tear is formed in the anal lining or perianal skin. Approximately 235,000 new cases occur in the United States every year. They can be caused by trauma to the anal area from passing large stools, constipation, while wiping, or during childbirth. Symptoms include sharp pain with bowel movements, bright red blood on the toilet tissue, and an itching sensation around the anus. Most fissures will heal with topical ointments. When topical treatments are not effective, injecting Botox into the internal anal sphincter can be curative. Rarely surgery is required to treat a fissure. “

Anal Cytology

A swab (similar to a Q-tip™) is inserted into the anal canal. The end of the swab will be rubbed against the skin inside the anus to collect cells. The cells are sent to the laboratory to be examined under a microscope. The cytologist evaluates if the cells appear normal or abnormal which determines if additional steps are needed. For patients at risk of anal cancer, anal pap tests should be repeated every 6 months – 2 years.

High Resolution Anoscopy

High resolution anoscopy (HRA) uses a special microscope to find abnormal areas of the anus and lower rectum. A lubricated plastic anoscope is inserted into the anus. Then, a piece of gauze moistened with acetic acid (vinegar) is placed to allow abnormal lesions to be visualized. The health care provider reinserts the anoscope and uses a colposcope (a machine with a light source and high definition magnifying lenses) to examine the from the perianal area to the distal rectum. Iodine is also used to help define potentially abnormal lesions. If abnormal areas are seen, the provider may take small biopsy (These are very superficial and about the size of a sesame seed that sent to the pathologist for evaulation).

Botox Treatment for Anal Fissure/Spasm

Most fissures will heal with topical therapy (like creams or ointments). When topical treatments are not effective, injecting Botox into the internal anal sphincter can be curative. The procedure can be done with or without sedation. Botox results in a temporary partial paralysis of the internal sphincter muscle, thereby preventing sphincter spasm for three to six months. Most fissures will heal during this time. Anismus and levator ani syndrome occur when the pelvic floor muscles spasm, resulting in anal or pelvic pain, painful intercourse, or urinary difficulties. Treatment options include medications, pelvic floor physical therapy, and Botox injections. We can develop a plan to help treat these conditions We will work with your insurance company to obtain coverage for the medication and procedure.

Fistula Surgery

Approximately one third of patients with a perianal abscess will develop a fistula. The treatment of a fistula depends on the patient’s medical conditions and anatomy of the fistula tract. An MRI can be obtained to help develop an operative plan. Most patients are treated with a simple fistulotomy. This is done in the office while the patient is under light sedation. During the procedure the length of the tract is opened, and the tract’s lining is thoroughly removed. The area is left open to heal from the inside. When a fistulotomy is not a safe option, treatments include the placement of setons, ligation of the intersphincteric fistula tract (LIFT), and rectal mucosal flaps.

Hemorrhoid Surgery

For patients whose hemorrhoids require an operation, there are several options. External hemorrhoids and skin tags can be excised in the office, with or without sedation provided by our anesthesiologist. Options for problematic internal hemorrhoids that cannot be treated by rubber band ligation include excisional hemorrhoidectomy, sclerotherapy and hemorrhoid artery ligation with mucopexy. We will discuss which option makes the most sense for you.

Treatment of Pilonidal Disease

Simple pilonidal abscesses can be drained in the office with local anesthesia. Sometimes patients develop chronic pilonidal disease that necessitates excision of the entire inflamed area. The wound can be left open to heal on its own, but in most cases a flap of tissue is created to close the wound and decrease the recovery time. Patients will be given tips to decrease the risk of recurrence after surgery.

Sexually Transmitted Infection Screening & Treatment

Sexually transmitted infections (STIs) are infections which can be passed from one person to another through sexual contact and are caused by bacteria, viruses, and parasites. Gonorrhea, Chlamydia, syphilis, and Human Immunodeficiency Virus (HIV) are passed through sexual contact including oral, anal, vaginal intercourse, or exposure to bodily fluids. Human papillomavirus (HPV), and herpes virus can be spread through skin-to-skin or sexual contact. HIV and Syphilis are diagnosed through bloodwork. Gonorrhea and Chlamydia are diagnosed with urine, throat, genital, and/or rectal swabs (each location where you are exposed should be tested). Herpes and human papillomavirus are typically diagnosed only if symptoms are present. Bacterial STIs, including gonorrhea, Chlamydia, and syphilis are treated with antibiotics (pills and/or injection) and after being treated the infection is gone. These infections may come back if you are exposed again so it is important to inform sexual partners of STIs so they can be tested and treated as well. Viral STIs, including HPV and herpes cannot be cured but are managed with medication or procedures depending on the frequency and severity of symptoms.

THD (Transanal Hemorrhoidal Dearterialization)

During the procedure, the surgeon fully inserts the anoscope and places a stitch in the rectum that occludes one of the hemorrhoidal arteries. This stitch also serves as an anchor to lift the hemorrhoid tissue inside. The suture is used to tie off the hemorrhoid, traveling externally. Upon closing the knot, the prolapsed tissue is lifted inside restoring the anatomy. The scarring process induced by mucopexy helps to stabilize and affix the tissues to the underlying rectal muscle.The surgeon gently extracts the anosope, protecting the mucopexy and repeats the procedure moving clockwise. The procedure is normally performed in a day surgery setting and the patient is normally discharged 1 hour after surgery. The mean operative time is approximately 30-60 minutes and the patient can typically return to normal activities in 2-3 days on an average.

THD® Doppler method offers durable results in mucosal prolapse and all grades of hemorrhoids, with advantages and benefits for the patient:

  • Minimally invasive procedure: non-excisional, preserves the anorectal physiology and the vital function of hemorrhoids. The procedure results in short recovery times, quick return to normal activities, and minor post-operative bleeding.
  • Low recurrence rate: unlike most non-excisional procedures, it has a low recurrence rate.
  • Repeatable: unlike excisional hemorrhoid surgery, it can be performed multiple times, as needed
  • Very low risk for major complications

View Explainer Video of Procedure

Contact us today to schedule your consultation and take the first step towards a healthier, happier you.

Contact us today to schedule your consultation and take the first step towards a healthier, happier you.

Laser Surgery Care

Contact

FrontDesk@LaserSurgeryCare.com

Hours

Mon: 9:00AM-6:00PM

Tue: 8:00AM-4:00PM

Wed: 9:00AM-6:00PM

Thur: 8:00AM-4:00PM

Fri: 8:00AM-1:00PM

Office

Address: 420 W 23rd St # Pb1f

New York, NY 10011