Anal Problems

1
Anal Problems

• First 15cm on rigid sigmoidoscopy
• Levator ani
• Internal sphincter
• (autonomic)
• External sphincter
• (voluntary)
• Vascular cushions

2
Anal Canal

• Upper
• Superior rectal av
• (inf. mesenteric)
• Inf. mesenteric lymph.
• autonomic
• Lower
• Inferior rectal av
• (internal iliac)
• Superf. inguinal lymph.
• somatic

3
Ano-rectal pain and bleeding
PAIN
Fissure-in-ano
Haemorrhoids
Perianal haematoma
Perianal abscess
Tumour of the anal margin
BLEEDING (bright red)
Haemorrhoids
Fissure-in-ano
Colon and rectal ca.
Diverticular disease
Ulcerative colitis
4
Haemorrhoids

• Symptoms and Signs
• Bright red rectal bleeding,
• prolapse, mucus, pruritis ani,
• pain on thrombosis, anaemia
• Management
• Exclude other causes of bleeding
• Conservative, Sclerotherapy, Banding,
  Haemorrhoidectomy

5
Fistula in Ano

• Symptoms and Signs
• Initial abscess with discharge
• recurrent perianal infection
• and persistent discharge
• Management
• Examination under anaesthetic
• Superficial and low-level fistulae laid open
• High fistulae low part laid open, upper part
  tied with seton

6
Perianal Haematoma

• Symptoms and Sign
• Tense, smooth, dark blue, cherry-sized lump at
  anal margin
• Acute onset, sudden pain
• Management
• Drainage under local anaesthetic
• Hot baths

7
Perianal Abscess

• Symptoms and Signs
• Painful, tender perianal swelling
• with discharge
• Management
• Examination under anaesthetic, MRI, US
• Surgical incision and drainage
• Antibiotics

8
Perianal Warts

• Symptoms and Signs
• Cornified epithelial lesions
• often in clusters
• Discomfort, pain, pruritis ani
• Management
• Most resolve spontaneously (2 years)
• Silver nitrate / podophyllin
• Curettage

9
Anal Carcinoma

• Symptoms and Signs
• Anal verge palpable mass,
• pain, bleeding, discharge,
• pruritis ani
• Anal sphincter incontinence
• Management
• EUA, sigmoidoscopy, biopsy
• Early radiotherapy (inc. inguinal lymphatics)
• Late surgery, colostomy

10
Rectal Prolapse

• Symptoms and Signs
• Discomfort, bleeding and mucus on defecation,
  tenesmus, incontinence, protrusion
• Management
• Conservative
• Surgical

11
Problems in Childhood

• Imperforate anus (with fistulation)
• 1/5000 new-born infants, especially males
• Partial rectal prolapse
• Confined to the mucosa, self-curing
• Congenital megacolon /Hirschprung disease
• Absent distal autonomic ganglion cells in
  myenteric plexus

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