Anorectal disorder
From Wikipedia, the free encyclopedia
| Anorectal disorder | |
|---|---|
 | |
| Specialty | Colorectal surgery  |
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]
| 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] |  |