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Coloproktology

Team of doctors surgical procotology:
Dr.ⁱⁿ Marijana Ninkovic
Dr.ⁱⁿ Elisabeth Gasser

and the medical team of the lower GIT:
Priv.-Doz. Dr. Reinhold Kafka-Ritsch
Assoz.-Prof. Priv.-Doz. Dr. Alexander Perathoner

Spezialsprechstunden
Special consultation hour coloproctology
(complex diseases of the large intestine and anus)
each Wednesday
Tel. +43 (0)50 504 50010

Special consultation hour for pelvic floor diseases
(as part of the Kontinenz- und Beckenbodenzentrum Innsbruck): 
every last Monday of the month
Tel. +43 (0)50 504 50010

Special consultation hour for HPV diseases
(lesions of human papilloma virus peri/anal)
each Tuesday
Tel. +43 (0)50 504 50010

Are you a patient? Find out more about coloproctological diseases.

Are you a medical colleague and interested in an internship for coloproctology in our department? Find out more about our attendance program and registration criteria.

Are you a medical colleague and interested in the further education and training opportunities of our working group? Find out more about our course and congress offer of the department an about the courses of the Austrian Working Group for Coloproctology (ACP)  of the Austrian Society for Surgery.

Regarding the three basic ACP courses (anatomy, end sonography and pelvic floor), please refer to the section on advanced training, congresses under the advertised courses..

Together with other departments of the Medical University of Innsbruck we also design the certified Pelvic Floor Center Innsbruck, for more information please visit the homepage of the Beckenbodenzentrum.

Diagnostics, treatments and examples of clinical pictures

At the beginning a conversation between doctor and patient takes place, for this purpose findings or reports as well as already performed imaging (MR, CT, ...) of a previous visit to the doctor are helpful.

The examination is then performed. We recommend cleaning the rectum with a small enema 1-2 hours before the examination. The doctor not only assesses the skin, but also carefully palpates the anal canal with the index finger to assess changes in the rectum and the function of the sphincters. Afterwards, the doctor performs a rectal endoscopy. This examination is practically painless and does not require anesthesia or sedation. This is followed by a consultation in which the further treatment is determined.

Methods of examination in coloproctology are proctoscopy (endoscopy of the rectum and anal canal), rectoscopy (mostly flexible device for endoscopy of the colon), transanal and transperineal sonography (ultrasound examination of the anal canal and the sphincter), colon transit time measurement (colon function) and anomanometry (measurement of sphincter function). Dynamic pelvic floor magnetic resonance imaging (imaging of the defecation act to assess pelvic floor function) or CT (computed tomography) or MRI (magnetic resonance imaging) are performed at the University Hospital of Radiology.in close cooperation with other departments such as dermatology, gynecology, urology, radiotherapy, gastroenterology and neurology, further examinations are performed and patients are also treated together. Colonoscopy (endoscopy of the entire colon) and small intestine examinations are performed in the Surgical Endoscopy Outpatient Clinic of our surgical clinic.

Treatments

We perform many treatments on an outpatient basis and under local anesthesia, such as taking samples of suspicious skin lesions, rubber band ligatures for low grade hemorrhoids or removal of minor growths. Smaller operations can also be performed under short anaesthesia during the day (e.g. obliteration of genital warts), so that the patient can leave the clinic on the same day. Other operations, such as operations for Crohn's disease or ulcerative colitis, pelvic floor prolapse, fistula operations, surgical treatment of hemorrhoids or resection of the rectum are performed under inpatient conditions.

Anal fistulas

As a consequence of abscesses in the anal region, fistulas can develop or remain, which are mostly weeping connecting passages between the anal canal / rectum and the perianal region. These can repeatedly lead to abscesses and ultimately to destruction of the sphincter muscle. An exact representation of possible fistula ducts by examination during the first operation (abscess relief) or by means of imaging techniques (fistula X-ray, ultrasound or magnetic resonance imaging) on the one hand, and a complete removal of these ducts by means of special surgical procedures on the other hand, are the key to a successful treatment of fistula suffering, which often lasts for years.

Haemorrhoidal diseases

Every human being has a zone of hemorrhoidal tissue in the anal canal from birth. These are located about 1-4 cm inside and consist of pads that lie under the mucous membrane and are filled with more or less blood depending on the functional performance. The hemorrhoids help the sphincter muscle to seal the rectum and to recognize the stool, they thus have an important function. Only when these hemorrhoid cushions continue to increase in size and move downwards, so that they can finally be felt and reduced as lumps in the anus and cause complaints such as itching, bleeding, weeping or pain, is it called hemorrhoidal disease. In the beginning, the lumps can be pushed back up into the anal canal, but if the condition persists, the hemorrhoids are permanently on the outside.

Mostly a predisposition is present, but pregnancies, chronic constipation, lack of exercise and sedentary occupations are also blamed for the occurrence of hemorrhoidal disease.

How are hemorrhoids treated?

The range of treatment for mild hemorrhoidal disease extends from general recommendations such as stool regulation, avoidance of hard pressing during bowel movements and excessively long bowel movements to drug therapy (suppositories, ointments or tablets) or the prevention or sclerotherapy of enlarged hemorrhoidal cushions. If the hemorrhoids are more advanced, we recommend surgery. This can mean the removal of the enlarged hemorrhoidal cushions or the gathering of the rectal mucosa and thus pushing back the prolapsing hemorrhoids. Today, most patients who are operated on using new methods can be discharged home no later than the second day after the operation.

Anal fissures

Anal fissures are a frequent and painful proctological clinical picture. An anal fissure is an elongated defect in the very sensitive skin of the anal margin. Anal fissures are not only caused primarily by local irritation in the case of very hard stool or diarrhea, but also secondarily as an accompanying disease, e.g. after surgery or in the case of chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis). In rare cases, a malignant tumor or an infectious disease (e.g. syphilis) can also be hidden behind an anal fissure. The treatment includes mainly conservative and less frequently surgical measures, the latter being more likely to be used in the case of prolonged anal fissures (chronic anal fissures).

HPV infections in the anal region

Anogenital infections with human papilloma viruses (HPV) have been increasing in recent years, especially in younger generations due to early sexual activity. There are almost 200 different known types of the virus. After years of existence, HPV infections can be associated with malignant tumors in the genital and anal regions. Therefore, a precise clarification is necessary not only by the gynaecologist, but also by the surgeon in the anal region and sometimes by the urologist. The most common HPV infections in these areas manifest themselves as genital warts (condylomata acuminata), which can be treated with ointments or surgically by laser or ablation with an electric knife in a short anaesthetic. We offer a special consultation hour for this purpose with the possibility of day surgery.

Chronic inflammatory intestinal diseases (Crohn's disease - ulcerative colitis)

Conservative or drug therapy is the central component in the therapy of chronic inflammatory bowel diseases. Approximately 50% of patients suffering from chronic inflammatory bowel disease require surgical intervention during the course of the disease. The necessity or sense of a surgical intervention and, above all, the "timing" of an operation is decided on an interdisciplinary basis between gastroenterologists, surgeons and with the patient. For all elective surgeries, i.e. those planned in the inflammation-free interval, a precise preoperative clarification and definition of the surgical strategy is essential. A well informed patient, who understands the necessity of the operation and the operation strategy, contributes significantly to a better result and a course without complications. Furthermore, preoperative optimization of the nutritional status and immunosuppression is important.

Emergency surgery: In case of bleeding, perforation (intestinal rupture), severe colitis with sepsis or intestinal obstruction, only emergency surgery can defuse the life-threatening situation.

Planned (elective) surgery: A common indication for elective surgery is so-called therapy-refractory disease, i.e. a disease that does not respond adequately even after all conservative therapeutic measures have been exhausted. The same applies if an adequate quality of life cannot be achieved or in case of severe side effects caused by conservative therapy. Furthermore, surgical therapy is indicated in any suspected case of malignant degeneration of the disease, i.e. already in the presence of high-grade dysplasia in the colon or in the suspected malignant degeneration of a fistula in Crohn's disease.

Surgical strategy: While the goal in Crohn's disease must be a segmental operation with as little bowel involvement as possible, the goal in ulcerative colitis is usually the complete removal of the colon. In most cases, however, it is possible to preserve the function of the sphincter muscle by means of an ileum pouch with colo-anal anastomosis. Especially for first-time operations, the operation is performed at our center laparsocopically, i.e.: in the sense of keyhole surgery by means of a few small incisions video-assisted. In addition to better cosmetic results, a faster convalescence and an improved body image can be achieved.

Fecal incontinence - a taboo subject?

If stool and wind can no longer be consciously held back, this is called fecal incontinence. There are many different causes of fecal incontinence and in most cases several factors must coincide for a person to become incontinent. About 1 - 3% of the total population and all age groups are affected by this problem. Although many people suffer from fecal incontinence, there are still inhibitions about talking about it and consulting a doctor about it. Those affected are usually unaware that there are very good treatment options available today, both conservatively and surgically. However, the key to successful therapy is undisputedly an exact recognition and precise clarification of the problem and symptoms. Therefore, an open discussion with your treating physician is the first important step towards improving your quality of life. We offer care for this patient within the framework of our interdisciplinary managed pelvic floor center. More detailed information can be found on the homepage.

The pelvic floor can cause many clinical pictures and is therefore often treated by gynecologists and urologists as well as surgeons. Specialized pelvic floor training by a trained physiotherapist plays an important role in the primary treatment of diseases of the pelvic floor. Here we work together with physiotherapists throughout Tyrol and the surrounding provinces. Psychological care can also be offered within the framework of our center. Sometimes special operations are also necessary, which have a positive effect on both the prolapse (e.g. prolapse of the intestinal mucosa) and the continence performance.

Coccyx fistula / Sinus pilonidalis

Coccyx fistula is a clinical picture that is characterized by ingrown hairs in the subcutaneous fatty tissue. It leads to chronic inflammatory irritation and the formation of deep fistula ducts. The affected patients suffer mainly from pain when sitting, as well as weeping and acute abscesses in the coccyx region.

If recurrent abscesses occur, which are then opened acutely, we recommend surgical repair of the entire affected tissue. During the operation, the duct system and the chronic inflammatory tissue are removed. Subsequently, we aim for a primary closure of the defect in order to avoid a large wound defect that would have to heal over several weeks. For our good success rate an operation under general anesthesia as well as an inpatient stay with limited movement for about 5 days is necessary.