3- anorectal disorders Flashcards
what are main causes of sore bum?
- hemorrhoids (main one)
- fissure in ano
- fistula in ano
- solitary rectal ulcer
- chronic anal pain
are haemorrhoids common?
- common
- usually internal
- rarely present as emergencies
what are presenting symptoms of haemorrhoids?
- pain (not severe, just a bit sore) - aches after a poo
- blood, pus, mucus - staining in underwear
- ask about continence (any accidents)
- tenesmus = feeling like something up bum, feels like you still need poo
- itch
what control is internal anal sphincter under?
involuntary control
what is grading system for hemorrhoids?
- bleeding not out
- bleeding in & push out themselves
- bleeding push back in
- bleeding and out all time
do hemorrhoids go away?
come and go throughout life - because thin skin in anus lining (clever) and they create a seal
what is treatment for hemorrhoids?
- conservative →diet & lifestyle - also topical, anusol (local anaesthetics only use for a few days and steroids only for 7 days)
outpatient →can band hemorrhoids if on anti-platelets/anti-coagulants as can bleed a lot = suck hemorrhoid in tube and fire elastic band around
what are some do’s and don’ts when hemorrhoids?
Do
- drink fluid & eat fibre
- wipe bottom with damp paper
- paracetamol
- warm bath
- ice pack wrapped in wet towel
- push pile back in
- exercise regularly
- cut alcohol & caffeine
Don’t
- don’t wipe too hard
- don’t ignore urge to poo
- don’t push hard to poo
- no painkillers containing codeine as cause constipation
- no ibuprofen if piles bleeding
- not too much time on toilet
if bad stage 4 hemorrhoids - what surgery can be done?
HALO and THD = fancy banding, put stitches through →not sore
after need topical analgesia and oral non-opiate
- use stool softener like laxido and have bed rest
what is thrombosed external hemorrhoid?
popping blood vessel when strain for poo
what is anal fissure?
= common
- like pain for split lip
- patients get fear of going to toilet
- often say they scream when defecation
- may result in sentinel tag and hypertrophied
what is bleeding and pain ratio like for fissures and hemorrhoids?
fissure = pain with a bit of bleeding
hemorrhoids = bleeding with a bit of pain
what can help fissures?
- must avoid jaggy poos, 30g fibre a day
- recommend sitz bath (get on amazon) →just put on toilet with hot water and sit in it
what are topical therapies for anal fissures?
- GTN (vasodilator - get thumping headache, supposed to for 8 weeks but patients don’t like but cheap)
- diltiazem cream (expensive but works well)
if topical therapies don’t work for anal fissures - what is next treatment?
then botox into internal sphincter (botox A) →helpful if poor compliance or if overweight
what is surgery for fissures?
sometimes do lateral internal sphincterotomy = heals fissure →but causes farts & skids (not common)
what is surgery for extreme fissures?
plasty operation where patch with a tag (always think about why extreme - crohn’s, sexual assault)
what is the stepwise approach to treatment for anal fissures?
- mandatory conservative measures = soft stool, baths, pain killers, lidocaine
- GTN or diltiazem (8 weeks)
- examination under anaesthesia or botox
- patient choice - oral ,flap etc
what are anal fistulas treatment?
- can cut between 2 and lay open (good for small fistulas)
- setons →holds open and stops getting infected
- permacol paste/plugs (pig collagen)
- video assisted anal fistula treatment
- Ligation of the Intersphincteric Fistula Tract
what is risk for cutting and laying up for treatment of small fistulas?
risk is cutting through sphincter causing skids & farts
what is solitary rectal ulcer syndrome?
multiple ulcers or sores, happens in prolapsing rectums or when on nicorandil
what is done in treatment for chronic anal pain?
- history
- examine
- proctoscopy
- sigmoidoscopy
- examination under anaesthesia
- MRI
- amitriptyline/painkillers
- reassure
what is treatment of anal skin tags?
surgery = usually when feeling self conscious →low priority
