Around the anus

Prutitis ani

• Itch occurs in the anus is moist or soiled
• Caused by fissures, incontinence, poor hygiene, threadworm, lichen sclerosis, anxiety, contact dermatitis
• Treatment
  • Better hygiene
  • Most wipe after defecation
  • Try anaesthetic cream

Fissure in ano

• This is a midline longitudinal split in the squamous lining of the lower anal canal
• If chronic it often occurs with a sentinel mucosal tag at the external aspect
• 90% are posterior – anterior ones occur following parturition
• Spasm may constrict the inferior rectal artery causing ischaemia, making healing difficult
• Generally caused by constipation, other causes include syphilis, herpes, trauma, Crohn’s, anal cancer, psoriasis
• Try 5% lignocaine ointment
• Advise extra fluids and high fibre diet
• GTN ointment
• Botulinum toxin

Fistula-in-ano

• The fistula tract between the skin and the anal canal or rectum
• Goodsall’s rule- determines the path of the fistula track between the openings, if anterior the track is in a straight line, if posterior the opening is always at the 6 o’clock position
• Causes;
• Abscesses
• Crohn’s disease
• TB
• Diverticular disease

Anorectal abscess

• Usually caused by gut organisma
• Can be; perianal, ischiorectal, intersphincteric, superlevator
• Redness and swelling may spread well into the buttocks
• Do incision and drainage
• Associated with; DM, Crohn’s malignancy

Perianal haematoma

• Also called a thrombosed external pile
• Strictly both names are wrong because it is actually a clotted venous saccule
• Appears as a 2-4mm dark blue berry under the skin

Pilonidal sinus

• Obstruction of natal cleft hair follicles around 6cm above the anus with ingrowing of hair results in a foreign body reaction, abscesses and smelly discharge
• Treatment is with excision of the tract and primary closure

Rectal prolapse

• The mucosa or the rectum with all its layer may descend through the anus
• This leads to incontinence in 75%
• De to a lax sphincter and prolonged straining

Anal cancer

• Increased risk with syphilis, anal warts and homosexuality
• Mostly squamous cell
• Patient presents with bleeding, pain, change of bowel habit, puritis ani, masses, stricture
• Treatment is with radiotherapy and chemotherapy