Anorectal and Pelvic Floor Disorders

Question 1

What is the function of the anorevtum?

Answer 1

To maintain continence
To control defaecation

Question 2

What is the main presentation of haemorrhoids?

Answer 2

Bleeding PR which is painless, usually caused by straining

Question 3

Surgery is often not required in the treatment of haemorrhoids but what can be done if surgery is required in an outpatient setting?

Answer 3

Rubber band ligation

Question 4

Which other surgeries can be performed which do not occur in an out-patient setting?

Answer 4

HALO- haemorrhoid artery ligation operation
Haemorrhoidectomy

Question 5

How will people with anorectal fissures present?

Answer 5

Little bleeding upon wiping, pain present.

Question 6

What is the underlying cause of an anorectal fissure?

Answer 6

Constipation

Question 7

What is the medical management of an anorectal fissure?

Answer 7

GTIN ointment
Ligocaine

Question 8

What is the surgical management for anorectal fissure?

Answer 8

Botox
Sphincterotomy (not the full sphincter is removed or the patient will be fully incontinent).

Question 9

What is the presentation of perianal abscess?

Answer 9

Excruciating pain
Signs of systemic sepsis

Question 10

What are the risk factors for perianal abscesses?

Answer 10

BMI
Diabetes
Immunosuppressants
Trauma

Question 11

What is the treatment if the perianal abscess is septic?

Answer 11

Antibiotics

Question 12

What is the treatment if the perianal abscess is not septic?

Answer 12

Incision and drainage of abscess

Question 13

What causes a fistula in ano?

Answer 13

Peri-anal sepsis

Question 14

What is the presentation for a fistula in ano?

Answer 14

Persisting pus discharge with each flair-up

Question 15

How can fistulas in ano be treated?

Answer 15

Very difficult to treat- 50% surgery failure

-Can use Seton to drain sepsis/mature tract
-Sphincter preseveration

Question 16

What is the presentation for anal cancer?

Answer 16

-Painful/painless
-Bleeding
-Indurated (firm or hard)
-Red flag symptoms
-Positive FIT test

Question 17

Which investigations can be used to diagnose anorectal disroders?

Answer 17

PR examination
Proctoscopy
Rigid sigmoidoscopy
Colonoscopy/ flexi sigmoidoscopy

Question 18

Which investigation can be do if colonoscopy fails or you can get a good colonoscopy for someone with an anorectal disorder?

Answer 18

CT colonscopy

Question 19

Which investigation can be used to rule out sepsis in the anrectum?

Answer 19

MRI

Question 20

When would you give a patient with an anorectal disorder a CT scan?

Answer 20

If they are frail and cannot have a CT colonoscopy.
However, this will probably mean they are unable to undergo any surgical procedures.

Question 21

Which investigation is useful for staging of rectal cancers?

Answer 21

MRI

Question 22

What can Colonic Transit Studies be used for?

Answer 22

Constipation

Question 23

What can anorectal manometry be used for?

Answer 23

Assessing anal sphincter function

Question 24

What can endoscopic ultrasound be useful for in anorectal disorders?

Answer 24

Outlines anatomy of sphincter so can show abnormalities

Question 25

What can anoscopy be useful for?

Answer 25

Surveillance of anal carcinomas

Question 26

What is pelvic floor dysfunction?

Answer 26

Wide range of symptoms relating to defaecation

Question 27

In those with pelvic floor dysfunction, what is important to think about in terms of history?

Answer 27

Patient may have a history of abuse

Question 28

What are the causes of pelvic floor dysfunction?

Answer 28

Child-birth related
All others causes e.g. surgery, abuse, perianal sepsis.

Question 29

What happens to the pelvic floor muscles after childbirth?

Answer 29

Become thinner and weakened

Question 30

Who is usually affected by pelvic floor disorders?

Answer 30

Usually women but can affect men.

Question 31

What is chronic constipation?

Answer 31

Difficulty or reduced frequency of defaecation

Question 32

What can cause chronic constipation?

Answer 32

-Diet
-Drugs
-Organic
-Functional

Question 33

Name two conditions which can cause organic chronic constipation.

Answer 33

Ehrler’s Danlos (!!!)
Hirschsprung

Question 34

How would chronic constipation be assessed?

Answer 34

Exclude sinister pathology
Detailed history
Colonic Transit Studies
Defecating portogram

Question 35

How can chronic constipation be treated?

Answer 35

-Irrigation (the process of washing out an organ or wound with a continuous flow of water or medication).
-Some surgical options e.g. sigmoid colectomy, subtotal colectomy with ileostomy/ ileorectal anastomosis.

Question 36

What are the types of faecal incontinence?

Answer 36

Passive
Urge
Mixed
Overflow

Question 37

What is passive incontinence related to?

Answer 37

Internal sphincter defect

Question 38

What is urge incontinence related to?

Answer 38

Rectal pathology/ functional issues

Question 39

What is mixed incontinence related to?

Answer 39

Prolapse

Question 40

What is overflow incontinence related to?

Answer 40

Constipation

Question 41

How is faecal-incontinence assessed?

Answer 41

Detailed history to determine type
Clinical examination
Anorectal physiology
Endo-anal ultrasound
Defaecatory programme

Question 42

Anal manometry assesses the function of the anal sphincter. How does this happen?

Answer 42

-Measures resting pressure, squeeze increment, duration of squeeze.
-Estimates length of anal canal

Question 43

What is the management for Figure Incontinence of the pelvic floor?

Answer 43

Low fibre diet
Pelvic floor exercises
Irrigation
Anal plug