Hemorrhoids are part of our body and form an additional closure of the intestinal outlet. They are a erectile tissue that is filled when at rest and emptied before bowel movements, thus enabling passage. Hard stools or chronic diarrhea can irritate these hemorrhoids, causing them to swell and become inflamed. Each subsequent bowel movement then irritates the enlarged nodes again. Depending on the severity, treatment is conservative with medication, rubber bands, laser, ligation of the supplying vessels, or surgical removal. 

Anal fissures typically occur as a result of hard stools or diarrhea. They are usually located in the rear part of the anal canal towards the coccyx. Treatment for fresh anal fissures consists of conservative therapy with painkillers, stool regulation, and a cream that slightly relaxes the underlying sphincter muscles. The pain causes the muscles to tense up even more, which leads to more pain and impaired healing. If conservative treatment is not sufficient, the defective scar tissue of the fissure must be surgically removed. The wound can then heal undisturbed. In individual cases, the defect must be covered with a flap plasty.

Anal fistulas must be treated by specialists, as their treatment is difficult and the risk of recurrence is very high. The course through or at least close to the sphincter muscles is also prone to complications. The focus is on accurate diagnosis; before actual treatment, splinting using drainage is usually necessary. Laser procedures can be used for suitable fistulas.  

It affects all age groups and both sexes, with older women being the most commonly affected. Often, there is a history of multiple pregnancies. The severity ranges from involuntary flatulence to unnoticed loss of formed stool. After a detailed diagnosis, appropriate therapies are initiated, ranging from medication to pelvic floor therapy with biofeedback to surgery. Surgical approaches include sphincter reconstruction and sacral nerve stimulation/modulation. The latter is particularly suitable for all age groups and shows excellent results. 

Pelvic floor weakness occurs mainly in older women, often after pregnancies that may have taken place decades ago. Symptoms range from incontinence to the feeling of not being able to empty properly. This applies to both the bowel and the bladder. Diagnosis is therefore often multidisciplinary, and surgical interventions often require a joint approach between surgeons, urologists, and gynecologists. 

This often leads to a prolapse of the bowel with protrusions toward the vagina or even an invagination of the bowel into itself. Both prevent proper bowel emptying. In addition, the pelvic floor can descend so far that the small intestine slips into the pelvis and puts additional pressure on the bowel, which hinders emptying. In most cases, this can be operated on using a minimally invasive technique, i.e., keyhole surgery.

Rectal prolapse describes a circular protrusion of the rectum in front of the anus. The symptoms are manifold and patients' quality of life is severely impaired. This must be surgically repaired. The procedure can often be performed transanally, and stapling devices are frequently used to shorten the excess intestine, with the suture then lying in the anal canal without external wounds. If higher parts of the intestine, such as the rectum, protrude, minimally invasive surgery, i.e., keyhole surgery, can also be performed. The intestine is then essentially “reattached” so that it can no longer slip down.

The pilonidal sinus originates from ingrown hairs. It is typically found above the coccyx between the buttocks, i.e., where there is the most pressure, for example, when sitting. Inflammation with pain and abscess formation occurs repeatedly. The cause must be eliminated by removing the hairs under the skin so that permanent healing can take place. There are various procedures, depending on the severity of the condition. In some cases, a laser can be used. Often, however, the entire lesion must be surgically removed, and the defect is then covered with a skin flap.