Surgery - Anal & Peri-anal Symptoms

Question 1

Anal and perianal symptoms

Answer 1

Anal Bleeding

Anal pain and discomfort

1. Haemorrhoids
2. Sentinal pile
3. Intersphincteric abscess
4. Perianal haematoma
5. Proctalgia fugax - shooting pains

Perianal itching/Irritation

Perianal Discharge

Question 2

Anal and perianal symptoms

Approach to investigation of anal and perianal symptoms

Answer 2

Inspection of the anal area, careful digital rectal examination (DRE) and proctoscopy are mandatory

Question 3

Anal and perianal symptoms

Digital rectal examination

Answer 3

Purpose

• Inspection of the anal and perianal area for skin changes and lesions
• Palpation of the anal canal and lower rectum and surrounding tissues.
• Normally the firm walls of the anal sphincter are felt over the first 5 cm or so. Above that level, the rectal walls are soft

Inspection

• Sentinel pile; excoriation; ulceration, perianal haematoma; fistulous opening; scars; abscess; prolapsed mucosa or haemorrhoids; skin tags

Palpation

• In lumen: faeces/blood/foreign body
• Crohn’s/anal carcinoma/lack of normal softness
• Prostatic enlargement/frozen pelvis
• Mass in pouch of douglas

Question 4

Anal and perianal symptoms

Digital rectal examination

Proctoscopy

Answer 4

Direct visualisation of mucosa of anal canal

Findings:

Inflammation/Ulceration/Haemorrhoids/bleeding/prolapse

Anal Carcinoma/Rectal Ulcer/Pus/Fistiula/Fibrous Polyps

Melanoma

Question 5

Anal and perianal symptoms

Digital rectal examination

Rigid Sigmoidoscopy

Answer 5

As for proctoscopy for 10 cm or so. Obturator removed and proximal end closed with lens.

Gentle inflation whilst inspecting lumen, manipulating and advancing ’scope with least discomfort to patient

Faecal loading may prevent visualisation; pain may limit examination to lower rectum only