Anal Disease

Question 1

Presentation of haemorrhoids

Answer 1

-Painless rectal bleeding= painless, bright red bleeding, not mixed in with stool
-Pruritus
-Pain if piles are thrombosed
-Soiling with third or fourth degree piles

Question 2

Investigation of haemorrhoids

Answer 2

-Examination
=External (below dentate line, prone to thrombosis)
=Internal (above dentate line, prolapses)

-1st degree= no prolapse
-2nd degree= prolapse when straining and return on relaxing
-3rd degree= prolapse when straining, do not return of relaxing, can be pushed back
-4th degree= prolapsed permanently

-Proctoscopy

Question 3

Management of haemorrhoids

Answer 3

-Soften stools: increased dietary fibre and fluid intake
-Topical local anaesthetics and steroids
-Rubber band ligation superior to injection sclerotherapy
-Surgery for large symptomatic haemorrhoids

Question 4

Presentation of anal fissure

Answer 4

-Painful, bright red, rectal bleeding
-Posterior midline
-Tearing sensation on passing stool
-Longitudinal or elliptical tears of the squamous lining of distal anal canal

Question 5

Management of anal fissure

Answer 5

-Acute
=Soften stool (high fibre, fluid intake, bulk-forming laxative)
=Lubricants before defecation
=Topical anaesthetics
=Analgesia

-Chronic
=GTN topic
=Sphincterotomy
=Botulinum toxin

Question 6

Presentation of perianal abscess

Answer 6

-Patients may describe pain around the anus, which may be worse on sitting;
-They may have also discovered some hardened tissue in the anal region;
-There may be pus-like discharge from the anus;
-If the abscess is longstanding, the patient may have features of systemic infection.

Question 7

Investigation of perianal abscess

Answer 7

-Inspection of the anus and digital rectal examination
-Colonoscopy and blood tests such as cultures and inflammatory markers
-MRI and transperineal ultrasound

Question 8

Management of perianal abscess

Answer 8

-Treatment is usually surgical, with incision and drainage being first line, usually under local anaesthetic.
-The wound can then either be packed or left open, in which case it will heal in around 3-4 weeks
-Antibiotics can be of use, but are only usually employed if there is systemic upset secondary to the abscess, as they do not seem to help with healing of the wound after drainage.