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Anorectal disorder

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imageHuman anus-en.svg
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Anorectal disorders include conditions involving the anorectal junction as seen in the image. They are painful but common conditions like hemorrhoids, tears, fistulas, or abscesses that affect the anal region. Most people experience some form of anorectal disorder during their lifetime. Primary care physicians can treat most of these disorders, however, high-risk individuals include those with HIV, roughly half of whom need surgery to remedy the disorders. Likelihood of malignancy should also be considered in high risk individuals. This is why it is important to perform a full history and physical exam on each patient. Because these disorders affect the rectum, people are often embarrassed or afraid to confer with a medical professional.

Common conditions

ConditionSymptoms and SignsDiagnosisTreatmentImage
Hemorrhoids (External and Internal)Anal bleeding, anal pain, painful defecation.Visual Exam, Digital Rectal Exam, Anoscopy, Exam under anesthesia if pain is not tolerated.last1=Fontemfirst1=Rodrigue F.title=Internal Hemorrhoiddate=2022url=https://www.ncbi.nlm.nih.gov/books/NBK537182/work=StatPearlsplace=Treasure Island (FL)publisher=StatPearls Publishingpmid=30725867access-date=2022-03-16last2=Eyvazzadehfirst2=Daniel}} Stool softeners, increased water intake to 64oz or more daily, regular exercise and bowel habits, topical analgesics.[[File:Hemorrhoid.pngthumb]]
Anal Tears and Fissures.last1=Zaghiyanfirst1=Karen N.last2=Fleshnerfirst2=Phillipdate=March 2011title=Anal Fissurejournal=Clinics in Colon and Rectal Surgeryvolume=24issue=1pages=22–30doi=10.1055/s-0031-1272820issn=1531-0043pmc=3140330pmid=22379402}}Visual Exam, Digital Rectal Exam, Anoscopy.Nitrates]] and calcium channel blockers to relax the sphincter, Botulinum Toxin injection.[[File:Anal fissure.JPGthumb]]
Anorectal Abscess and Fistulalast1=Sigmonfirst1=David F.title=Perianal Abscessdate=2022url=https://www.ncbi.nlm.nih.gov/books/NBK459167/work=StatPearlsplace=Treasure Island (FL)publisher=StatPearls Publishingpmid=29083652access-date=2022-03-18last2=Emmanuelfirst2=Bishoylast3=Tumafirst3=Faiz}} Bloody diarrhea, an opening can point to a fistula, with or without drainage with itchiness.Visual Exam, Digital Rectal Exam, Anoscopy, Imaging (CT, MRI) of the fistula tract, endoanal ultrasound, Labs, exam under anesthesia.Surgical Therapy: Incision and Drainage, Fistulotomy, Fistulectomy, Seton-Primary Drainage of the Fistula, Ligation of intersphincteric Fistula Tract (LIFT), Advancement Flap for Anal Fistula, Anal Fistula Plug, Video-Assisted Anal Fistula Treatment (VAAFT).[[File:Abscess diag 02.svgthumbAbscess locations.]]

Symptoms and signs

Itchiness, a burning sensation, pus discharge, blood, and swelling in around the rectum and anus, diarrhea. Other common symptoms include anal spasm, Bleeding with defecation and painful defecation.

Diagnosis

Doctors uses a variety of tools and techniques to evaluate the type of anorectal disorder, including digital and anoscopic investigations, palpations, and palpitations. The initial examination can be painful because a gastroenterologist will need to spread the buttocks and probe the painful area, which may require a local anesthetic.

Treatment

Treatments range from recommendations for over-the-counter products to more invasive surgical procedures.

Among the most common outpatient advice given to patients with less severe disorders include a high-fiber diet, application of ointment, and increased water intake. More serious procedures include the removal of affected tissue, injection of botulinum toxin, or surgically opening the fistula tract in the sphincter muscle.

Notes

References

  1. (April 2018). "Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings". Annals of Coloproctology.
  2. (14 July 2009). "What every gastroenterologist needs to know about common anorectal disorders". World J Gastroenterol.
  3. "Anorectal disorders". The Free Dictionary by Farlex.
  4. Ehrenpreis, Eli. (2003). "Anal and Rectal Diseases Explained". Remedica.
  5. (2020-01-01). "Benign Anorectal Conditions: Evaluation and Management". American Family Physician.
  6. (2022). "External Hemorrhoid". StatPearls Publishing.
  7. (2022). "Internal Hemorrhoid". StatPearls Publishing.
  8. (March 2011). "Anal Fissure". Clinics in Colon and Rectal Surgery.
  9. (March 2016). "Anal Fissure". Clinics in Colon and Rectal Surgery.
  10. (2022). "Perianal Abscess". StatPearls Publishing.
  11. (2022). "Anorectal Fistula". StatPearls Publishing.
  12. Givel, Jean-Claude. (2009). "Anorectal and Colonic Diseases: A Practical Guide to their Management". Springer.
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