Anorectal disorders include conditions involving the anorectal junction[1] as seen in the image. They are painful but common conditions like hemorrhoids, tears, fistulas, or abscesses that affect the anal region.[2][3] Most people experience some form of anorectal disorder during their lifetime.[4] Primary care physicians can treat most of these disorders,[2] however, high-risk individuals include those with HIV, roughly half of whom need surgery to remedy the disorders.[4] Likelihood of malignancy should also be considered in high risk individuals.[5] This is why it is important to perform a full history and physical exam on each patient.[5] Because these disorders affect the rectum, people are often embarrassed or afraid to confer with a medical professional.[2]
| Anorectal disorder | |
|---|---|
 | |
| Specialty | Colorectal surgery  |
Common conditions
edit| Condition | Symptoms and Signs | Diagnosis | Treatment | Image |
|---|---|---|---|---|
| Hemorrhoids (External and Internal) | Anal bleeding, anal pain, painful defecation.[5] | Visual Exam, Digital Rectal Exam, Anoscopy, Exam under anesthesia if pain is not tolerated.[6] | Non-Surgical Therapy: High Fiber Diet (25g/day for women and 38g/day for men),[7] Stool softeners,[6] increased water intake to 64oz or more daily,[7] regular exercise and bowel habits,[7] topical analgesics.[5]
Surgical Therapy.[5] |
 |
| Anal Tears and Fissures. | Anal Pain, Anal Spasm, Bleeding with defecation.[8] | Visual Exam, Digital Rectal Exam, Anoscopy.[9] | Non Surgical Therapy: Constipation relief, avoid anal trauma,[8] Topical Nitrates and calcium channel blockers to relax the sphincter,[8] Botulinum Toxin injection.[9]
Surgical Therapy (for chronic fissures or when non-surgical therapy fails) : Anal Dilation,[8] Lateral Internal Sphincterotomy, Advancement Flaps, Fissurectomy. |
 |
| Anorectal Abscess and Fistula | Painful swelling,[5] Redness, Pain,[10] Bloody diarrhea,[11] an opening can point to a fistula, with or without drainage [5] with itchiness.[12] | Visual Exam, Digital Rectal Exam, Anoscopy, Imaging (CT, MRI) of the fistula tract, endoanal ultrasound, Labs,[11] exam under anesthesia.[11] | Surgical Therapy: Incision and Drainage,[10] 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).[11] |  |
Symptoms and signs
editItchiness, a burning sensation, pus discharge, blood, and swelling in around the rectum and anus,[4] diarrhea.[12] Other common symptoms include anal spasm, Bleeding with defecation[8] and painful defecation.[5]
Diagnosis
editDoctors 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.[2]
Treatment
editTreatments 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.[2]
Notes
edit- ^ Lee, Jong Min; Kim, Nam Kyu (April 2018). "Essential Anatomy of the Anorectum for Colorectal Surgeons Focused on the Gross Anatomy and Histologic Findings". Annals of Coloproctology. 34 (2): 59–71. doi:10.3393/ac.2017.12.15. ISSN 2287-9714. PMC 5951097. PMID 29742860.
- ^ a b c d e Schubert, Moonkyung Cho; Sridhar, Subbaramiah; Schade, Robert R; Wexner, Steven D (14 July 2009). "What every gastroenterologist needs to know about common anorectal disorders". World J Gastroenterol. 15 (26): 3201–3209. doi:10.3748/wjg.15.3201. PMC 2710774. PMID 19598294.
- ^ "Anorectal disorders". The Free Dictionary by Farlex. Retrieved 14 October 2012.
- ^ a b c Ehrenpreis, Eli (2003). Anal and Rectal Diseases Explained. Remedica. ISBN 978-1-901346-67-1.
- ^ a b c d e f g h Cohee, Mark W.; Hurff, Ashlee; Gazewood, John D. (2020-01-01). "Benign Anorectal Conditions: Evaluation and Management". American Family Physician. 101 (1): 24–33. ISSN 1532-0650. PMID 31894930.
- ^ a b Lawrence, Aaron; McLaren, Emily R. (2022), "External Hemorrhoid", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29763185, retrieved 2022-03-16
- ^ a b c Fontem, Rodrigue F.; Eyvazzadeh, Daniel (2022), "Internal Hemorrhoid", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 30725867, retrieved 2022-03-16
- ^ a b c d e Zaghiyan, Karen N.; Fleshner, Phillip (March 2011). "Anal Fissure". Clinics in Colon and Rectal Surgery. 24 (1): 22–30. doi:10.1055/s-0031-1272820. ISSN 1531-0043. PMC 3140330. PMID 22379402.
- ^ a b Beaty, Jennifer Sam; Shashidharan, M. (March 2016). "Anal Fissure". Clinics in Colon and Rectal Surgery. 29 (1): 30–37. doi:10.1055/s-0035-1570390. ISSN 1531-0043. PMC 4755763. PMID 26929749.
- ^ a b Sigmon, David F.; Emmanuel, Bishoy; Tuma, Faiz (2022), "Perianal Abscess", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29083652, retrieved 2022-03-18
- ^ a b c d Jimenez, Mercy; Mandava, Nageswara (2022), "Anorectal Fistula", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 32809492, retrieved 2022-03-18
- ^ a b Givel, Jean-Claude (2009). Anorectal and Colonic Diseases: A Practical Guide to their Management. Springer. ISBN 978-3-54069418-2.