Your questions, answered by the specialist

A proctological examination, when carried out by an experienced specialist, is generally well tolerated. It is performed with the patient in the lateral position, progressively and with adequate lubrication. Anoscopy — which allows visualisation of the anal canal — may be slightly uncomfortable but is not painful in most cases.

If there is an active anal fissure or another painful condition in the anal region, the examination may sometimes not be possible at that appointment. In such cases, it is preferable to treat the condition preventing the examination first, and perform it once resolved, ensuring a complete diagnosis without unnecessary discomfort for the patient.

It depends on the type of procedure. Outpatient techniques such as rubber band ligation or foam sclerotherapy are performed without anaesthesia and are virtually painless at the time, with only mild discomfort or a sensation of pressure in the hours that follow.

At the ONEstep® clinic we use minimally invasive techniques that minimise discomfort and allow rapid recovery.

The number of sessions varies according to the grade of the haemorrhoids and the technique used — whether foam sclerotherapy or rubber band ligation. In most cases, a single treatment session is sufficient to resolve the problem. Some haemorrhoids, depending on their size or characteristics, may require a complementary second session.

Following the initial assessment I will advise on the most appropriate technique and number of sessions for your particular case.

Pain improvement is usually noticed within the first 7–10 days following the injection, as the botulinum toxin reduces internal sphincter spasm and allows the tissue to receive oxygen and regenerate.

Complete healing of the fissure typically occurs between 6 and 12 weeks, with a healing rate of up to 70% in correctly selected chronic fissures. During this period it is essential to maintain a fibre-rich diet, adequate hydration, and the prescribed topical treatment, to avoid hard stools that perpetuate the lesion.

These are two distinct conditions, although both affect the anal region. An anal fissure is a small wound at the edge of the anus that causes intense pain during and after defecation, with bleeding. It is usually related to constipation or excessive straining.

An anal fistula is a pathological tract connecting the anal canal to the perianal skin, usually following a previous abscess that has not healed, with intermittent discharge. Both conditions have specific and different treatments, which is why an accurate diagnosis is essential.

In the vast majority of cases, yes. Haemorrhoid procedures — rubber band ligation and foam sclerotherapy — can resolve more than 90% of grade I, II and III haemorrhoids without surgery. Even certain selected grade IV haemorrhoids can be successfully treated with these non-surgical techniques.

Surgery is reserved for large grade IV haemorrhoids that have not responded to previous non-surgical procedures. At the ONEstep® clinic we assess each case individually and always prioritise the least invasive options when they are effective.