Frequently asked questions about proctology – clearly explained for patients

Hemorrhoids – Frequently asked questions

Many people suffer from enlarged haemorrhoids – also known as “anal lumps”, “lumps on the bottom” or “haemorrhoidal disease”– over the course of their lives. Typical symptoms such as burning, itching or traces of blood on toilet paper are not only unpleasant, but also a nuisance in everyday life. In this section, we answer the most frequently asked questions about causes, treatment and prevention.

• What are hemorrhoids and how do they develop?

Hemorrhoids are actually normal vascular cushions in the rectumthat everyone has. They support the fine closure of the anus. Only when these vascular cushions enlarge or igniteThis is called hemorrhoidal disease. Various factors can cause hemorrhoids to swell: Frequently heavy pushing during bowel movements (e.g. chronic constipation) is a trigger, as the high pressure dilates the blood vessels in the anal area.

Even prolonged sitting on the toilet, being overweight, lack of exercise and a low-fiber diet promote hemorrhoids. In women Pregnancy and birth contribute to the development of hemorrhoids through increased pressure in the pelvis and hormonal changes. In addition, sometimes a Genetic predisposition also plays a role – if there is a high incidence of hemorrhoids in the family, your own risk is increased.

Important to know: Hemorrhoids are nothing unusual or shameful – they are a very common condition that many people suffer from at some point in their lives.

• What symptoms indicate hemorrhoids?

Enlarged haemorrhoids can cause a number of unpleasant symptoms cause. Typical are above all bright red blood on toilet paper or in the stool (bleeding during bowel movements), itching and burning in the anusoozing or mucus discharge as well as a foreign body sensation in the anus.

Many sufferers have the feeling that the bowel is not emptying completely, which leads to frequent urge to defecate. Pain occurs mainly with external haemorrhoids as these are located in an area with more nerves – you can then feel painful, swollen nodules on the anus. Internal haemorrhoids (which are located in the anal canal) are usually painlessbut can bleed. However, severe pain can occur if a hemorrhoidal nodule develops. thrombosed (forms a blood clot) or if prolapsed hemorrhoids become trapped.

The symptoms often depend on the degree of severity: in the early stages, haemorrhoids may only cause slight itching or a little blood from time to time, while in advanced stages there is permanent discomfort and visible lumps on the outside. If you notice one or more of these symptoms, a proctological examination is worthwhile – the earlier, the better hemorrhoids can be treated.

• How are hemorrhoids diagnosed?

The diagnosis The diagnosis of hemorrhoids is made by our proctologist through a consultation and a brief examination. First, you describe your symptoms and previous illnesses (medical history).

This is followed by a physical examinationExternal haemorrhoids are usually recognized immediately by the doctor as soft, possibly reddened lumps around the anus. With careful palpation, he can determine whether enlarged cushions are palpable in the anal canal. This is also important, Other causes of anal discomfort anal fissures (tears in the mucous membrane), anal fistulas, abscesses or, very rarely, polyps and tumors. Therefore, a small Proctoscope (short tube with light) inserted to view the inside of the rectum.

This proctoscopy is painless and only takes a few minutes. If more severe bleeding is reported or for safety reasons in older patients, a Colonoscopy (colonoscopy) is recommended to rule out other diseases of the colon.

However, visual inspection, palpation and proctoscopy are usually sufficient to determine whether and to what extent a hemorrhoidal disease is present.

Tip: Don’t be afraid of the examination – it is over quickly and provides clarity about your complaints.

• What options are there for hemorrhoid treatment in Berlin?

Hemorrhoid treatment at our Berlin Proctology Center depends on the degree of severity of the complaints. We often start with conservative measuresespecially for hemorrhoids in the early stages (grade 1-2). These include Dietary changes (eating a high-fiber diet to keep the stool soft), drinking plenty of fluids, and stool regulators if necessary, to avoid pressing. Also Sitz baths (e.g. with camomile or oak bark) can relieve itching and support healing.

Local help Ointments or suppositories from the pharmacy that contain anti-inflammatory and pain-relieving active ingredients – they temporarily relieve symptoms such as itching or burning.

If these measures are not sufficient, various minimally invasive procedures are available, which we can perform directly on an outpatient basis in Berlin:Rubber band ligation is a tried and tested method in which small rubber rings are placed around the internal hemorrhoids so that they die and fall off after a few days – this is quick and virtually painless. The Sclerotherapy (sclerotherapy by injecting a drug) is often used to shrink hemorrhoids.

Smaller hemorrhoids can also be treated with infrared light (infrared coagulation). An innovative method is the Hemorrhoid artery ligation (HAL-RAR)in which the blood vessels supplying the haemorrhoids are specifically ligated – minimally invasive and usually under local anaesthetic.

For advanced haemorrhoids (grade 3-4) or very stubborn cases, surgerycan be performed. become necessary. Classically, the Hemorrhoidectomythe complete surgical removal of the lumps. Alternatively, there is the gentler Stapler method (stapler hemorrhoidopexy), in which excess hemorrhoid tissue is removed and the remaining tissue is pulled up and fixed – this method often causes less pain and allows faster healing.

In our proctology center we also use modern methods such as laser therapy in which haemorrhoids are precisely removed with a laser or sclerosed – this can accelerate wound healing. The proctologist will discuss with you individually which treatment is best in your case. Basically, we rely on modern, gentle procedures that can be performed on an outpatient basis and without general anesthesia whenever possible.

• Do hemorrhoids always require surgery?

No, not every hemorrhoid needs to be operated on. In many cases, hemorrhoids can be treated conservatively or minimally invasivelywithout traditional surgical intervention. In particular We can manage mild to moderate hemorrhoidal disease (grade 1-2, but also many grade 3) with measures such as ointments, rubber band ligations or sclerotherapy.

Surgery is usually only considered if there are pronounced hemorrhoids (grade 3-4) that constantly prolapse, cause great discomfort or if minimally invasive methods do not bring the desired success. Even then, we choose as Tissue-sparing techniques.

For patients, the prospect of surgery is understandably unsettling – but we provide you with comprehensive information beforehand and use methods that are as painless as possible are. Many procedures can be performed on an outpatient basis, so you can go home the same day.

The decisive factor is: Don’t hesitate for fear of surgeryto see a proctologist. The earlier hemorrhoids are treated, the sooner surgery can be avoided. And if an operation does become necessary, you are in experienced hands with us and will receive the best possible care.

• How can I prevent hemorrhoids?

To prevent hemorrhoids or avoid recurrence, it helps to adjust some lifestyle habits. The focus is on a High-fiber dietEat vegetables, fruit, whole grains and legumes daily to promote soft, regular stool consistency. Avoid prolonged constipation by drinking enough fluids (at least 1.5-2 liters of water per day).

Regular exercise is also important – even moderate activity such as walking or light exercise promotes bowel activity and venous blood flow, which reduces the pressure in the rectum.

Get into the habit of not pushing too hard when not to push too hard and not sitting for too long – take your time, but don’t spend ages on the toilet (put your cell phone or newspaper to one side). Losing excess weight can also help to reduce the pressure on the pelvic veins.

After all thorough but gentle anal hygiene Finally, thorough but gentle anal hygiene is advisable: do not rub or rub too aggressively so as not to irritate the skin (use soft toilet paper, a bidet or damp washcloth if necessary, but avoid perfume and alcohol in wet wipes).

These preventive measures can help prevent hemorrhoids from developing in the first place – or prevent them from returning so quickly after successful treatment.

Anal fissure – Frequently asked questions

An anal fissure is a painful, small tear in the skin of the anus – known to many as a “tear in the anus” or “bloody bowel movement”. Doctors speak of a “fissura ani“. Stinging pain occurs particularly during or after a bowel movement. In this section, we answer the most frequently asked questions about the causes, treatment options and chances of recovery.

• What is an anal fissure and how does it develop?

An anal fissure is a painful tear in the mucous membrane of the anal canal. This is also colloquially referred to as a Anal fissure. A fissure usually occurs when the sensitive anal mucosa is damaged. is suddenly overstretched or injured.

The most common trigger is hard stools due to constipation – if you have to press hard, the skin can tear. But also repeatedly Diarrhea-like stools can irritate the mucous membrane and lead to tears.

Other risk factors are heavy pushing (e.g. due to habit or time pressure) and trauma to the anal area, for example due to very hard toilet cleaning or, in rare cases, medical interventions.

In some patients, inflammatory bowel diseases (such as Crohn’s disease) contribute to the development of anal fissures, as the mucous membrane may be pre-damaged and have a poorer blood supply.

In terms of frequency anal fissures can occur at any age, in both men and women. Important to know: A distinction is made between Acute anal fissures (freshly formed, often heal within a few weeks) and chronic anal fissures.

The latter persist for longer than ~6-8 weeks and do not heal by themselves – hardened edges or small skin flaps (so-called “sentinel skin” or mariske) have often formed here, which make healing more difficult. The earlier a fresh fissure is treated and the causes (e.g. constipation) are eliminated, the better chronicity can be prevented.

• What are typical anal fissure symptoms?

A fresh anal fissure is mainly characterized by severe pain during bowel movements noticeable. Those affected often describe a a burning or stabbing sensation of painwhich occurs particularly during and immediately after a bowel movement.

This pain can last from a few minutes to hours and is often so severe that Fear of the next visit to the toilet develops. This causes some people to retain stools, which then leads to constipation and further hard stools – a vicious circle.

In addition to the pain, there are often bright red bleeding occur: You usually see little, but fresh blood on the toilet paper or on the stool. Itching and burning in the anal area can also occur, especially if the wound is irritated or if some wound secretions leak out. Many patients also notice a Spasm of the sphincter muscle (sphincter spasm).

This muscle spasm is a reflex reaction to the pain: the inner sphincter muscle contracts, which further intensifies the pain and reduces blood flow to the fissure. With chronic anal fissures the above symptoms usually persist. Small nodules or skin folds form at the edge of the fissure (sentinel hemorrhoid), and the area is constantly irritated.

Summarized are Anal fissure symptomsexcruciating pain during bowel movements, light bleeding, itching/burning and often a cramped sphincter. If you have such complaints, do not hesitate to seek medical advice – even if it is a sensitive subject, there is effective help available.

• How do you treat an anal fissure? What can I do to help it heal?

The treatment of an anal fissure depends on whether it is acute or chronic, but always aims to break the cycle of pain and muscle spasm and promote healing of the wound.

Initially, conservative measures in the foreground, especially in the case of a fresh (acute) fissure. It is very important to make the stool soft and bowel movements easy: A A high-fiber diet (lots of vegetables, fruit, whole grains) and drinking enough ensure softer stools.

If necessary, stool softeners or mild laxatives can be used. (e.g. macrogol or lactulose) can be taken temporarily to prevent constipation. The following are very effective for anal fissures Sitz baths in warm water – ideally several times a day, especially after a bowel movement. A 10-minute warm sitz bath (possibly with the addition of camomile or oak bark) relaxes the sphincter, relieves pain and promotes blood circulation, which supports healing. After the bath, gently pat the anal area dry.

Furthermore Ointments and suppositories which have been specially developed for anal fissures. Typical active ingredients in fissure ointments are Nitroglycerin or calcium antagonists (e.g. diltiazem) in low doses – these dilate the blood vessels and relax the sphincter musclewhich relieves pain and promotes healing. Initially, nitrosalves can cause headaches, but there are alternatives. In addition, often Local anesthetics (lidocaine ointments) are prescribed to briefly break the pain peak – but these should only be used to a limited extent.

It is also important to thorough hygieneKeep the anal area clean, but avoid aggressive soaps.

If these conservative treatments do not bring sufficient improvement over a few weeks – which is particularly common with chronic anal fissures – there are minimally invasive and surgical measures.

A very successful minimally invasive procedure is the Botox injection into the sphincter muscle: In this procedure, a small dose of botulinum toxin is injected into the inner sphincter muscle, causing it to relax. The effect lasts for several months and during this time the fissure can heal at rest because the constant muscle spasm is eliminated. Botox treatment is carried out on an outpatient basis and is completed quickly.

In some cases, an anal anal dilatation (careful stretching of the anus under anesthesia) to relax the muscle – this method is used less frequently today as it is more uncontrolled and can lead to incontinence.

Lateral sphincterotomy is the surgical treatment for this condition as the gold standard for chronic anal fissures. Under anesthesia, a small part of the internal sphincter muscle is severed to permanently reduce the high pressure. This operation is very effective in experienced hands and usually leads to permanent healing, with minimal risk of permanent functional impairment.

Another surgical technique is fissurectomyin which the chronically inflamed tissue of the fissure is excised to create fresh, well-perfused wound edges – this is often combined with a sphincterotomy or the wound is covered with a mucosal flap. Such procedures are usually performed on an outpatient basis or with a short hospital stay.

Conclusion: Most anal fissures can be treated without surgery can be healed if the above measures are implemented consistently. It is important to break the spiral of pain – then the mucous membrane has time to heal. Our proctologists in Berlin will work with you to choose the gentlest treatment so that you can quickly return to a pain-free life.

• How long does it take for an anal fissure to heal?

The healing time depends greatly on whether the anal fissure is fresh or already chronic. Acute anal fissures can often heal within 2 to 4 weeks if the triggering factors are eliminated (e.g. through soft stools and local ointment treatment).

Many sufferers feel significant relief after just a few days of consistent treatment – such as less pain during bowel movements – and the mucous membrane can recover.

Chronic anal fissures, on the other hand, which have been present for many weeks, take considerably longer to heal. take longer. This is due to the fact that in chronic fissures the edges of the wound are often hardened and blood circulation is poorer; sometimes there are accompanying skin lobules (marisci) or a persistent sphincter spasm. In such cases, you have to be patient and, under certain circumstances more intensive therapies (such as Botox or surgery) to heal the fissure for good.

It is important to stay on the ball during the healing phase: continue to eat a high-fiber diet, drink enough, apply the ointments carefully and attend follow-up examinations. The absence of pain is often the first sign that the fissure is healing, but even if the pain is gone, treatment should be continued for a while until the mucous membrane has completely regenerated.

Overall, the sooner the fissure is treated, the shorter the healing time usually is. And don’t worry – even a stubborn anal fissure can heal with modern therapy, even if it takes a little longer. We will guide you through the healing process and are always available to answer any questions you may have.

Anal fistula – Frequently asked questions

An anal fistula – also known medically as a perianal or anorectal fistula – is a small, inflamed passage near the anus, which usually manifests itself as oozing, pus or a “hole next to the anus”. Colloquially, many people also speak of a “pus spot on the bottom”. Here we explain the most important questions about the development, diagnosis and treatment of this often stubborn condition.

• What is an anal fistula and how does it develop?

An anal fistula is a small tubular canal (fistula tract)which forms between the inside of the anal canal and the outer skin of the anus. You can think of it as an unnatural connecting duct. An anal fistula usually develops as a result of a Anal abscess. An anal abscess is an acute accumulation of pus in the tissue next to the anal canal caused by a Infection of the anal glands or tiny cracks through which bacteria have penetrated. If such an abscess is not completely healed or drained, it can find a way out – a permanent duct, the fistula, then forms through which secretions can repeatedly drain outwards.

In short: First an abscess develops, from which a fistula can result. In addition to abscesses, there are rarely other causes of fistulas, e.g. chronic inflammatory bowel disease (Crohn’s disease can cause deep ulcers and fistulas) or certain infections. But in about 90% of cases the Cause of an anal fistula is a previous anal abscess. This means that many patients remember that they initially had severe pain and perhaps a fever (signs of the abscess), it may even have opened or burst open spontaneously – and then a fistula remained.

An Anal fistula does not heal on its own as intestinal contents and bacteria repeatedly migrate through the duct. Timely diagnosis and treatment is therefore important to avoid complications.

• How can you recognize an anal fistula (symptoms)?

An anal fistula can cause very unpleasant symptoms. cause. Those affected often notice constant or recurring discharge of pus or sore-like fluid from a small opening in the anal region. For example, you may see yellowish discharge or some blood in the panties or when cleaning. This discharge can also smell bad as it contains inflammatory secretions. It is often accompanied by Irritation of the skin and itching around the anus because the leaking fluid makes the skin sore.

Many patients also feel pain in the anal areaespecially when sitting, walking or having a bowel movement. The pain can sometimes be stronger, sometimes weaker – with an active abscess (when the fistula temporarily closes and pus builds up) it is sharp and strong, in quieter phases rather dull or as a feeling of pressure.

Sometimes there is slight swelling or redness can be seen or felt near the anal opening – this indicates inflammation or an abscess that is still present. With more severe inflammation, general symptoms such as fever, chills and fatigue may also occur.

Chronically affected people often report a changeable courseThere are phases in which little comes out of the fistula and there is hardly any pain, and then again phases with increased discharge, pain and possibly swelling (e.g. if a small pus deposit forms). This up and down is typical for fistulas.

In summary, you should think of an anal fistula if you have recurring pus/blood secretions in one area of your bottomassociated with local pain. In any case, this is a reason to see a proctologist, because if left untreated, a fistula can lead to recurring infections.

• How is an anal fistula diagnosed?

The diagnosis of an anal fistula is made by a thorough examination by a proctologist. is asked. First, the doctor will ask about your symptoms: e.g. how long have you had discharge or pain, did you have an abscess in the past, have you had a fever, etc.? This is followed by the Inspection of the anal area.

The doctor can often already see a small external opening (like a tiny dot or canal) in the skin near the anus, possibly with some secretions coming out. The area is also gently palpated – sometimes a cord running under the skin can be felt or pus is squeezed out.

However, in order to assess the course of the fistula precisely, additional examinations are usually necessary, as fistula tracts can branch out or run at different heights.

At our proctology center in Berlin, we often use an endoanal ultrasound: This is a special ultrasound via a probe in the rectum, with which the fistula tracts and their relationship to the sphincter muscle can be visualized very well.

For more complex fistulas, an MRI examination (magnetic resonance imaging) is also performed to obtain an exact “map image” of the fistula – particularly important before an operation so that no hidden branches are overlooked.

Sometimes the proctologist can also carefully insert a thin probe through the external opening (probing) to see where the duct leads – but this is only done if it can be done without pain.

In some cases, such as repeated fistula formation or suspected Crohn’s disease, laboratory tests or a colonoscopy may be necessary to clarify underlying diseases.

Overall, the diagnosis of anal fistulas today is gentle and accurate – we take the time to get to know the course of the fistula in detail before starting treatment.

• How do you treat an anal fistula?

The treatment of an anal fistula aims to close the inflammatory connection permanently and prevent further infections. In the In most cases, surgery is required – conservative methods can alleviate symptoms (e.g. with antibiotics or ointments), but the fistula itself rarely disappears without surgery.

First, if there is still an anal abscess If a fistula is present, it is drained (incision and drainage) to relieve the acute pressure and pain. Subsequently, or in the case of an existing fistula, the proctologist selects a suitable Surgical method depending on the location of the fistula:

Afistulotomy can often be performed for simple, superficial fistulas. can be performed. The fistula tract is opened lengthwise under anesthesia. splitThe wound is “cut open”, so to speak, and the inside of the duct cleans itself while the wound heals from the bottom up. This procedure has a very high healing rate for shallow fistulas.

However, if the fistula is deeper and runs through or close to the sphincter muscle, a more careful approach must be taken so as not to impair sphincter function.

In such cases we use, for example, the seton procedureA seton is a thin rubber thread that we place through the fistula and knot on the outside.

This suture remains in place for several weeks and keeps the canal open so that pus can drain away and the tissue can slowly separate from the suture – a controlled healing process that protects the sphincter muscle because it is not suddenly severed.

It is also possible to gradually knot the seton tighter so that the fistula is gradually cut (cutting seton).

For complicated fistulas, or if you want to preserve the sphincter muscle as much as possible, there are plastic procedures are available: e.g. the advancement flap-procedure.

Here, the inner fistula opening in the bowel is closed by suturing a small flap of mucous membrane over it after the fistula has been removed – this allows the sphincter muscle to remain intact.

Also modern is the VAAFT-procedure (video-assisted anal fistula therapy), which we offer in Berlin: This involves inserting a tiny endoscope into the fistula tract so that the surgeon can see the inside on the monitor. The fistula is then cleaned from the inside and closed using fine instruments or a laser. VAAFT is minimally invasive and comes without a large incision but is not suitable for all types of fistula.

Speaking of laser: In some cases, laser fistula laser fistula therapy (FILAC method), where a laser fiber catheter obliterates the duct from the inside and stimulates the tissue to scar. This technique is also very gentle and sometimes shortens the healing time.

After every fistula treatment thorough aftercare is important: regular wound checks, sitz baths and hygiene to ensure good healing.

An anal fistula should be treated as soon as possible, as waiting any longer can lead to more scarring and complications.

Our proctologists will suggest the best individual method – be it a classic operation or a modern minimally invasive procedure – to remove the fistula .

Thanks to today’s techniques, the chances of success are very high and in most cases we can preserve the sphincter muscle so that you are completely pain-free and continent again after healing.

Pilonidal sinus fistula – Frequently asked questions

Pilonidal fistula – also known as pilonidal fistula, hair fistula or “hole in the buttock” – is often characterized by a painful swelling or suppuration on the lower back, near the coccyx. It is medically referred to as pilonidal sinus. Here we explain how it develops, how to recognize it and what treatment options are available.

• What is a pilonidal sinus (coccyx fistula)?

The pilonidal sinus, colloquially often called coccyx fistula or “ingrown hair on the coccyx”, is a chronic inflammation in the area of the gluteal fold (coccyx region). This leads to the formation of a Cavity or duct system that is often filled with hair and flammable material.

The cause is usually that Hair growing into the skinHair lying in the gluteal fold bores into the skin through friction (for example when sitting or through tight clothing) and leads to inflammation.

Men are affected slightly more frequently than women, especially in young adulthood. Factors such as heavy sweating, lack of ventilation of the skin, obesity and long periods of sitting (e.g. professional drivers) increase the risk.

Initially, a pilonidal sinus may start like a pimple or small abscess on the coccyx – you may notice a painful, reddened swelling. However, when the acute stage passes, one or more small openings in the pore from which fluid or pus occasionally escapes: this is chronic fistula. If left untreated, a coccyx fistula causes repeated bouts of inflammation with pain, swelling and discharge of pus. In the worst case, larger abscesses can form, which also cause fever and severe discomfort.

In a nutshell: A pilonidal sinus is an annoying inflammation caused by ingrown hairs on the rump, which usually does not go away permanently on its own, but flares up again and again after it has subsided.

• What symptoms does a coccyx fistula cause?

The symptoms of a Pilonidal Sinus can be very inconspicuous at first and are not always recognized immediately. Those affected often notice Recurrent pain or feeling of pressure on the coccyx, especially when sitting or leaning backwards.

One or more small openings or skin holes can be made in the gluteal fold . may be visible, sometimes barely the size of a pinhead. From these openings occasionally fluid, pus or bloody secretions – you can then see stains in your underwear, for example, or it is noticeable when washing.

If an inflammatory episode (abscess formation) occurs, the pain increases significantly: the tissue swells, becomes red, overheated and very painful under pressure.

Such an abscess can drain (spontaneously or through a medical incision), which brings short-term relief, but as long as the fistula tract persists, the wound will not heal permanently. Some patients also report itching or burning in the area, especially when secretions come out and irritate the skin.

In advanced cases or in the case of acute spread, it can lead to fever and a general feeling of illness This indicates a larger abscess that requires urgent treatment.

A coccyx fistula can often be recognized by the characteristic tufts of hair in the wound: on medical examination, hair tips can sometimes be seen protruding from the fistula openings.

As a general rule, if you have recurring problems in the coccyx region – pain, swelling, oozing – you should think about a pilonidal sinus and seek proctologic clarification before the situation worsens.

• How is a pilonidal sinus treated?

The treatment of pilonidal sinus depends on the extent of the disease. In Early or mild cases, which may only show a small opening and minor inflammation, can initially be treated conservatively: Thorough hygiene and hair removal in the coccyx region is important to prevent further ingrown hairs .

Regular shaving or even better laser hair removal of the gluteal fold reduces the risk of new hairs growing in. In case of acute inflammation Antiseptics or antibiotics can be used locally and systemically to combat the bacteria – this can reduce the inflammation, but does not eliminate the fistula itself.

In most cases, surgical treatment is necessary to permanently remove the coccyx fistula. There are two classic procedures :

1. Excision with open wound healing

All inflammatory tissue and fistula tracts are surgically excised. The skin is not sutured shut, but the wound remains open and heals slowly from the bottom up.

This method ensures that all affected areas are really removed, but has the disadvantage of a longer wound healing time (several weeks) with regular dressing changes.

2. Excision with primary suture (or plastic coverage)

Once the fistula tissue has been removed, the wound is closed again directly – either by simply suturing it shut or by means of a flap plasty (a piece of skin/tissue is moved to cover the defect area).

The advantage is faster healing, but the disadvantage is a slightly higher risk of a new infection forming under the suture (slightly increased risk of recurrence).

For larger findings, special plastic procedures such as the Limberg flap plasty where a triangle of tissue is moved to flatten the region and thus remove the tension.

In addition to these conventional surgical methods, there are modern, minimally invasive procedures for pilonidal sinus, which we also offer in Berlin.

One example is the pit-picking methodIn this method, only the small fistula openings (“pits”) and the underlying fistula tract are removed without excising a large area.

The contents of the fistula are scraped out through a few small incisions and the openings are reduced in size. This procedure is less invasive and has short wound healing times, but is mainly suitable for smaller findings.

Also the laser therapy is also used: With the FILAC method (Fistula-tract Laser Closure) method, a laser fiber is inserted into the fistula tract and “cauterizes” the fistula tissue from the inside – similar to anal fistula treatment – so that the tissue scabs over and the fistula collapses.

The skin openings may need to be slightly widened or cleaned out, but no major cutting is necessary. Advantage: Hardly any scars, quick recovery, often possible on an outpatient basis.

Which method is best for you depends on your individual situation.

At our Proctology Center, we take a close look at every pilonidal sinus and advise you in detail. We can perform minor procedures We can perform outpatient surgery under local anesthesia, while larger operations are usually performed as day surgery or with a short inpatient stay.

Aftercare and prevention are important after every treatment : keep the wound clean, attend check-ups and ensure consistent hair removal and hygiene to prevent relapses.

With today’s treatment methods, the prognosis is very good – most of our patients are symptom-free after successful treatment of their coccyx fistula and are happy to be able to sit again without pain.

• How does a sinus pilonidal surgery in Berlin work?

The sinus pilonidal surgery are performed in Berlin using modern, gentle techniques. First, of course, you will be informed about the planned procedure. On the day of the operation you will either local anesthesia or under light anesthesia – many coccyx fistula procedures can be performed under local anesthesia on an outpatient basis; for larger fistulas, a short anesthesia (twilight sleep or general anesthesia) is often more comfortable.

During the operation, the patient lies in the prone position. Depending on the method, the surgeon will then Remove or close fistula tracts: In classic excision, the affected tissue is cut out in a spindle shape.

This sounds extensive, but it is a routine procedure – it usually only takes around 30-60 minutes, depending on the size of the findings. After removal, it is decided whether the wound left open or sewn is performed. If we use minimally invasive procedures (e.g. pit picking or laser), the skin incisions are very small and work is carried out specifically through these accesses. In any case, the region is sterilely bandaged at the end.

After the operation you will be taken to our recovery area and, in the case of outpatient procedures, can often return home after a short observation period. You will receive precise instructions on wound care (e.g. daily careful showering, plaster changes, sitz baths) and we arrange check-ups during our consultation hours.

The pain after coccyx fistula surgery can be managed well with normal painkillers; many patients are surprised that it is less severe than expected – especially if a painful abscess source has been removed beforehand, they feel immediate relief. Depending on your job, you should take it easy for a few days, especially if a lot of sitting is required (a seat ring or soft cushion can help).

If the wound is open, it will take several weeks for everything to heal completely – during this time you will have weekly check-ups. If the wound is sutured, the stitches usually come out after ~2 weeks. Overall, we take care to make sinus pilonidal surgery as uncomplicated as possible: On an outpatient basis, as far as possible, and using techniques that damage as little healthy tissue as possible.

Thanks to our experience and specialization in this surgery (it is performed very frequently at our center), you can be sure of an optimal result leave. Soon after the procedure, you will realize how beneficial it is to finally be rid of this chronic inflammation.

Further questions about proctological diseases

• What other proctological diseases does the Proctology Center Berlin treat?

Our proctology center in Berlin specializes in all diseases of the rectum and anal area – in addition to haemorrhoids, anal fissures, anal fistulas and Pilonidal Sinus, we also treat all other proctological conditions. These include, among others: Anal abscesses, i.e. acute accumulations of pus in the anus (these are opened and treated quickly to relieve pain and prevent fistulas).

We take care of Perianal thromboses or external hemorrhoid thromboses – these are painful blood clots at the edge of the anus, colloquially known as “anal cushions”; we can often open them immediately under local anesthesia so that the pain disappears.

Mariscus (harmless skin lobules on the anus, often left over after healed hemorrhoids or fissures) can also be removed if necessary if they are bothersome or cause problems with hygiene.

Anal eczema and itching (pruritus ani)which are caused by chronic irritation or allergies are diagnosed and treated by us (e.g. with ointment plans and advice on care). If there is a suspicion of If there are benign or malignant changes (e.g. polyps, anal carcinomas), we initiate comprehensive diagnostics and coordinate further treatment in close cooperation with specialists from the surrounding clinics – these important topics are also part of proctology.

In short: whatever your anal and rectal concerns, you can turn to us. Our specialists have extensive experience in proctology and will find a suitable solution for every problem.

Don’t hesitate to seek help for supposedly “embarrassing” complaints – we treat every concern with empathy and the highest level of professional competence. Your well-being and rapid relief of your symptoms are our top priority.

Many things can be improved with simple means, and for more complex clinical pictures we offer state-of-the-art treatment methods in Berlin.

You are in the best hands at VenaZiel Berlin MVZ. Your proctology team at Checkpoint Charlie wishes you good health!

Organizational issues and practice procedures

• Where is the Proctology Center in Berlin located and how do I make an appointment?

Our proctology center VenaZiel Berlin MVZ is centrally located in Berlin-Mitte, Charlottenstraße 13 (Checkpoint Charlie), 10969 Berlin. You can conveniently make an appointment, either by telephone at (030) 25299482 or online via our appointment booking portal (Doctolib). Send an e-mail to hallo@venaziel.de is also possible. We offer consultation hours from Monday to Thursday 8 am to 6 pm and Friday 8 am to 3 pm. Tip: When making an appointment, please briefly state your concern (e.g. hemorrhoids, anal fissure) so that we can schedule enough time. Our staff will help you in a friendly and discreet manner.

• Do I need a referral to get an appointment with a proctologist?

Yes, A referral is usually required for an appointment at our Proctology Center in Berlin. You can contact us directly – both those with statutory health insurance and private patients and self-payers are welcome. Simply bring your insurance card with you to your appointment. Above all, it is important to us that you seek help promptly if you have any complaints – we will take care of the rest.

• What happens during the proctological examination – do I need to prepare for it?

A proctological examination is carried out sensitively and in a calm atmosphere as follows. First, the doctor will have a confidential discussion (anamnesis) with you about your symptoms, pain or bleeding and any pre-existing conditions.

This is followed by a physical examination of the anal areaFirst, a careful external examination is carried out to see if, for example, haemorrhoids, cracks or fistulas are visible. Then the proctologist carefully feels the rectum. If necessary, a short instrument (proctoscope) is inserted to view the anal canal from the inside.

Do not worry: These examinations are usually not painfulcan be a little uncomfortable at best. Our experienced proctologists – such as Dr. Iryna Hertzsch and, from 01.06.2025, Mr. Ahmed Sultan – will proceed very carefully, explain every step to you and respect your privacy.

You do not need to make any special preparations; it is usually sufficient to go to the toilet as usual. If a small enema is required to improve visibility, this will be carried out gently on the spot. The aim of the examination is to clearly diagnose your symptoms so that we can then initiate the best possible treatment.

• Does health insurance cover the costs of examination and treatment?

Yes. The proctology consultation and necessary treatments are generally fully covered by the are generally covered in full by statutory health insuranceas long as they are medically necessary measures.

Our MVZ has a health insurance license, so those with statutory health insurance only need to bring their health insurance card. As usual, privately insured persons receive an invoice in accordance with the scale of fees for doctors, which is usually reimbursed by the private health insurance company. If, in individual cases, a special therapy is not covered by health insurance (e.g. some newer laser procedures or aesthetic corrections, if not medically indicated), we will inform you in advance.

In general, however, you can assume that examinations and standard treatments (ointments, rubber band ligation, operations, etc.) for hemorrhoids, anal fissures, anal fistulas and coccyx fistulas are covered by your health insurance. So don’t hesitate for cost reasons – your health comes first.