Anorectal pain Flashcards
haemorrhoids, fissure, fistulae, prolapse, perianal abscess (29 cards)
What are haemorrhoids
enlarged, symptomatic anal vascular cushions
What is the function of anal cushions
specialised submucosal tissue that help to control anal continence
RFs for haemorrhoids
- pregnancy
- obesity
- older age
- chronic coughing
- weight lifting
Where are haemorrhoids anatomically located?
Described as a clock face (patient on back with legs raised)
* 3 o’clock
* 7 o’clock: towards genitals
* 11o’clock: towards back
How do external and internal haemorrhoids differ
- external: originate below the dentate line, prone to thrombosis, may be painful
- Internal: originate above the dentate line
How are haemorrhoids classified?
- Grade I: Do not prolapse out of the anal canal
- Grade II: Prolapse on straining but reduce on relaxing
- Grade III: don’t return on relaxing but can be manually reduced
- Grade IV: Cannot be reduced
How do haemorrhoids present
- painless , bright red rectal bleeding
- pruritus
- pain if thrombosed
- palpable lump
How are haemorrhoids examined
- PR exam
- proctoscopy
How are haemorrhoids managed
- soften stools: increase dietary fibre and fluid intake
- topical local anaesthetics and steroids
- rubber band ligation
- injection sclerotherapy
What causes thrombosed haemorrhoids
strangulation at the base of the haemorrhoid, resulting in thrombosis in the haemorrhoid
How do thrombosed haemorrhoids typically present
significant pain and a tender lump
How will a thrombosed haemorrhoid appear on examination?
purplish, oedematous, tender subcutaneous perianal mass
How are thrombosed haemorrhoids managed
- presentation within 72hrs: admit and refer for excision
- > 72hrs: stool softeners, ice packs and analgesia
- Symptoms usually settle within 10 days
What is an anal fissure
A tear/split in the squamous lining of the distal anal canal.
When is an anal fissure considered acute vs chronic?
- Acute: < 6 weeks
- chronic: > 6 weeks
Name three risk factors for anal fissures.
- Constipation/ hard stool
- IBD
- pregnancy
- opiate analgesia
What are typical symptoms of an anal fissure?
- Painful defecation with bright red rectal bleeding
- tearing sensation on passing stool
- anal spasm
Where do 90% of anal fissures occur?
In the posterior midline.
What should be considered if anal fissures are in atypical locations?
Underlying conditions such as Crohn’s disease.
How are acute anal fissures managed?
- conservative: High-fibre diet, high fluid intake, topical analgesia
- bulk-forming laxatives
- topical diltiazem
- topical glyceryl trinitrate
How are resistant anal fissures managed
- if GTN fails after 8 weeks, refer to secondarycare
- consider surgery (sphincterotomy) or botulinum toxin
What is the most common form of anorectal abscess
perianal abscess
What is a perianal abscess?
A collection of pus in the subcutaneous tissue around the anus
Rfs for perianal abscess
- male
- anal fistulae
- Crohn’s disease
