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Painful anal conditions :Painful anal conditions :

Anal fissureProctalgia fugax Anarectal abscessPerianal heamotoma Complicated hemorrhoidsAnal cancer

• In 60% of cases , pus from the abscess give pure culture of E.coli

• 23%...... Pure culture of staph. Aureus.

• Others…… proteus , strept. Or mixed.

Microrganism….??

• fistula-in-ano (most common) • Crohn’s disesase• diabetes• immunosuppression

Anorectal abscesses should be treated by drainage as soon as the diagnosis is established .

an examination under anesthesia is often the most expeditious way both to confirm the diagnosis and to treat the problem.

Delayed or inadequate treatment may occasionally cause extensive and life threatening suppuration with massive tissue necrosis and septicemia

Antibiotics are only indicated if there is extensive overlying cellulitis or if the patient is immunocompromised

Antibiotics alone are ineffective at treating perianal or perirectal infection.

Peri-anal HematomaPeri-anal Hematoma

A perianal hematoma is a collection of blood under the surface of the skin at the edge of the anal opening.

1.History:Occurs at all ages.Male & female equally affectedThe patient often notices that the peri-anal skin is

moist & itchy.It’s occasionally multiple & may be recurrent.

2.Physical Examination• Position:

– The lump may be anywhere around the anal margin– More than one may present

• Color:– When the lump is close to the skin and the skin is not

edematous deep red-purple color– If the skin becomes edematous the redness of the

underlying blood clot can’t be seen

• Tenderness:– The lump is tender due to tension– edema & ulceration of the skin ↑ tenderness

• Shape & Size:

– The initial lump is spherical & up to 1 cm in diameter.

– The lump becomes polypoid if the skin is lax or or becomes edematous.

• Surface:

– Covered by normal r edematous skin– Smooth surface

• Composition:

– Central lump can be felt as solid, hard, hemispherical mass.

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• Acute phase:– Evacuate the hematoma through a small incision

under LA

• Discharging or absorbed hematoma hot pathes

HemorrhoidsHemorrhoids

• Painful hemorrhoids are:– 3rd degree hemorrhoidHemorrhoids that prolapse but must be pushed

back in by a finger.– Thrombosed hemorrhoid (containing blood clots)– Strangulated hemorrhoid– Ulcerated hemorrhoid

Physical Examination:Two or three tense, tender, red-purple mucosa

covered swelling protruding from the anal canal

Remember that major piles are at the 3,7 & 11 o’clock positions

The piles that have been prolapsed & thrombosed for a long time increase possibility to be ulcerated& infected they should be differentiated from prolapsing carcinoma or other gross pathology

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• Conservative• Avoid constipation & ensure bulky stool with increasing fiber content of

the diet.• Topical preparations containing local anesthetic agents & steroids.

• Thrombosed external hemorrhoids:• Bed rest.• Application of ice packs.• Oral analgesia + topical local anesthetic gel.• excision of the hemorrhoid or clot evacuation if the patient presents less than 48 hours

after the onset of symptoms

Sitz Bath

• Relaxes anal sphincter

• Decreases inflammation w/ Epsom® salts

• 10-15 minutes, 3-4 times/day

• Anal malignancy is rare and accounts for less than 2% of all large bowel cancers

• Uncommon tumour, which is usually a squamous cell carcinoma

• May affect the anal verge or anal canal• Associated with HPV• More prevalent in patients with HIV infection• Lymphatic spread is to the inguinal lymph nodes• Treatment is by chemoradiotherapy in the first

instance• Major ablative surgery is required if the above fails

• mass, bleeding, pain, discharge, itching, and tenesmus.

• more common in men

• Small, well-differentiated lesions ( < 3cm ) are treated by wide local excision.

• Deep lesions that involve the sphincters require abdominoperineal resection