Benign Ano-rectal Disorders Flashcards
What are haemorrhoids?
Enlarged vascular cushions in the lower rectum and anal canal
Presentation of haemorrhoids?
Rectal bleeding (bright red and not mixed with the stool) as well as discomfort and pruritus ani (itchy bottom). No change in bowel habit or weight loss. External inspection and PR exam may be normal but proctoscopy can help with diagnosis.
Treatment of haemorrhoids?
If symptoms are minor none is required apart from dietary advice on avoiding constipation.
Suppositories containing local anaesthetic and corticosteroids may be helpful.
If symptoms more severe: rubber band ligation, sclerosant or HALO (used in Tayside)
Risk of haemorrhoids operations?
Patient becoming incontinent
What happens in rectal prolapse? Two types?
Part of the rectum protrudes above the anus. This can be partial (just a bit of lining) or complete (full thickness)
Risk factors for rectal prolapse?
Women as they have a weaker pelvic floor.
Children can get it due to straining on the toilet.
Presentation of rectal prolapse?
Usually presents with a protruding mass from the anus especially during defection. The mass may reduce spontaneously. Bleeding and passing mucus per rectum is common.
Rectal examination of rectal prolapse usually shows
poor anal tone
If you have rectal prolapse what else are you likely to have
problems with anything else to do with the pelvic floor e.g. issues with the bladder
Treatment of rectal prolapse? Problems?
Often old ladies are too frail for surgery so they have to be given bulking agents and education on manual reduction.
Different surgeries can be done though if the patient is fit enough.
What is an anal fissure?
A tear in the sensitive skin-lined lower anal canal distal to the dentate/pectinate line.
How can anal fissures occur?
As a primary problem or as a complication of Crohn’s disease.
Presentation of anal fissures?
Acute onset of severe pain usually following an episode of constipation. Bright red rectal bleeding.
How can diagnosis of anal fissures be made?
On history and perianal inspection
Treatment of anal fissures?
Initially try dietary advice and stool softeners. If that doesn’t work can use 0.4% GTN and 2% dilimiazem ointment for 6 weeks. Lastly can inject botox between the internal and external anal sphincter.
