Anorectal and pelvic floor disorders

Question 1

What is the presentation of haemorrhoids

Answer 1

bleeding - usually after wiping
Itching
painless
History of constipation

Question 2

What are the surgical options for haemorrhoids

Answer 2

HALO - ligate haemorrhoidal artery to shrivel up the tissue

RBL - rubber band ligation

Question 4

What is the presentation of an anal fissure

Answer 4

Bleeding
Pain

Question 5

What is the treatment of anal fissures

Answer 5

Treat underlying cause which is usually constipation

GTN/diltiazem + lignocaine

Surgical - botox injected into sphincter which relaxes it and increases blood flow to the fissure which aids in healing

Question 6

Which drugs can cause constipation

Answer 6

Aluminium antacids
Antimuscarinics (e.g. procyclidine, oxybutynin)
Antidepressants (most commonly tricyclic antidepressants, but others may cause constipation in some individuals)
Antiepileptics (e.g. carbamazepine, gabapentin, oxcarbazepine, pregabalin, phenytoin) Sedating antihistamines
Antipsychotics
Antispasmodics (e.g. dicycloverine, hyoscine)
Calcium supplements
Diuretics
Iron supplements
Opioids
Verapamil

Question 7

What is the treatment for chronic constipation

Answer 7

1. Laxatives first line
2. if 2 laxatives fail for 6 months then give lubiprostone

Question 8

What is the management of faecal incontinence

Answer 8

Low fibre diet

Loperamide

Pelvic floor exercises