Anal or rectal pain Thanks. share it kindly :) Hope it is not complicated and consistent!

1. Painful anal conditions
CA module
Written by : Karrar Raafat Arif
University of Baghdad
College Of Medicine
Supervisor : Dr.Moayad Abbas Fadel
Ministry of Higher Education and Scientific
Research
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Third grade

2. Objectives:
• Give a general description about anal pain.
• List some of the medical conditions associated with anal pain.
• Illustrate main symptoms and causes for common painful anal
conditions.
• Explain how to manage and treat common anal pain causes.
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3. Introduction:
Anal pain (proctalgia) is pain that occurs in or around the
anus and rectum (the last section of the large intestine that
ends in the anus). Pain and bleeding from the rectum often
accompany anal pain. People may feel embarrassed to ask
their doctor about anal pain, but it is a common symptom
of many different medical conditions such as abscesses,
hemorrhoids, or Crohn's disease. Diagnosis and treatment
are discussed.
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4. • Hemorrhoids (external & mixed)
• Anal fissures (fissures in ano)
• Anal fistula (fistula in ano)
• Anal abscess
• Anal cancer
• STDs (anal warts like in HIV patients with
fungal infection)
• Pruritis Ani(1)(6)
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Medical conditions associated with anal pain

5. Common causes of anal pain:
Anal fissures :
Anal fissure or fissure in ano is a
longitudinal tear or split in the skin
covering the distal anal canal below the
level of the dentate line, overlying the
lower half of the internal sphincter.
- Anal fissures commonly affects the
younger and middle age groups.(2)
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6. Common causes of anal pain :
• Anal fissures are classified into acute anal
fissures and chronic anal fissures
Symptoms:
Clinical symptoms include anal pain during
and after defecation, often accompanied by
bright-red rectal bleeding
and pruritus ani. (4)
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7. Causes of anal fissures :
• Hard stool (trauma)
• STDs
• Increased sphincter tone (spasm)
• IBDs (inflammatory bowel diseases)
• Other causes including (congenital
deformity).(1)(4)
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8. Management and treatment of anal fissues:
• (1 to 3)months trial of conservative
management. thus includes high-fiber diet.
• local lubrication ointment (5% lidocaine
ointment)
• Botulinum Toxin Type A Injection
Technique
• Surgery : lateral anal sphincterectomy
• Lord’s anal dilation
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9. Common causes of anal pain:
Hemorrhoids:
• Are symptomatic dilated hemorrhoidal veins in anal cushions in relation to anal
canal.
• “Hemorrhoid” derived from Greek words=(haem-) blood
• So common =(-rhoos) flowing
• Can affect any age group.
• Types : internal & external or mixed(both)
• There are 4 degrees of hemorrhoids
*(the most severe painful one is 3rd and 4th).(3)
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10. Ministry of Higher Education and Scientific
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External hemorrhoids Internal hemorrhoids Mixed hemorrhoid
1-Lie below dentate
line.
1- Varicose veins lie
above dentate line.
Baggy swelling formed
by combination of both
internal and external H.
2-innervated by cut.
Nerves.
2- NOT Exhibit same
characteristics
3-Can be turned into
Thrombosed
Hemorrhoids
3-Can be turned into
prolapsed Hemorrhoids
4-Do not cause
bleeding.
4-It can bleed when
irritated.
5-Painful 5-Painless Severe pain

11. Hemorrhoids
• Causes:
 Portal vein
obstruction(hyper-
tention and varicose
veins.
 Fibers deficient diet.
 Anal hypotonia
 Aging
 Sitting for prolong
periods(life style)
 Other causes like
pregnancy,ascites,
e.t.c.(3)
• Symptoms:
 Bleeding
 Protrusion
 Pain
 Discharge and
Irritation
 Anemia(3)
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• Complications:
 Profuse
hemorrhage
 Ulceration
 Strangulation
 Thrombosis
 Fibrosis
 Gangrene(3)

12. Hemorrhoids
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• Dignosis:
to confirm diagnosis of hemorrhoids
we should do some easy
procedures:
 Proctoscopy
 DRE(digital rectal examination)
 Sigmoidoscopy(1)
• Management & Treatment:
 Dietary and life style modification
1- (high –fiber foods).
2- Topical local anesthetic agents &
steroids.
3- warm or sitz bath.
 Taking Analgesic drugs(ibuprofin as
example).
 If those solutions failed then Rx
counters to Invasive procedures
(rubber band ligation,sclerotherapy)
 Surgery: Hemorrhoidectomy(3)(6)

13. Common causes of anal pain:
Anal cancers(Malignancy):
• Rare!
• Anal carcinomas comprise 1%–2% of all
bowel cancers.
• Squamous cell carcinoma accounts for 85% of
all cases. Adenocarcinoma comprises 10%and
5% verrucous carcinoma& melanoma.
• occur slightly more often in women than men.
(5)(6)
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14. Anal cancer
Causes of anal cancer
• Unknown (genetic mutation to anal
epithelial lining cells).
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Mutated gene

15. People at Risk to get anal cancer:
• HPV ++.
• Increased anal sexual activity.
• Smokers.
• History of cervical cancer.
• Drug history.
• Elderly age people(<50 years).
• Immunocompromised patients.(5)
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Anal cancer

16. Anal cancer
Symptoms
• Symptoms include bleeding,
itching, or discharge from the
anus. Pain in the rectum or
anus or the feeling of a rectal
lump or mass(may be a polyp)
and change in bowel habits.(5)
Diagnoses
• Digital Rectal
Examination (DRE)
• Anoscopy
• MRI
• CT scan. (5)
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17. Anal cancer
Management
Patients should:
• Follow good diet
• Get enough sleep.
• Practice safe sex .
• Be in touch with health care
provider for follow up. (5)
Treatment
• Chemotherapy
• Radiotherapy
• Surgery: excision of the
tumor.(5)
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18. Common causes of anal pain:
Anal abscesses:
 infected cavity filled with pus found near the anus or rectum .
• Usually infection cause is a microbial infection by (E-coli
,Staph.aureus)
• Anorectal abscesses may be associated with Crohn’s disease,
anal fissure, diabetes.
• Classified into 4 types of anal abscess these are : ischiorectal
, perianal,intersphincteric and supralevator abscesses.
• Symptoms: throbbing swelling and severe pain Exaggerated
when walking or coughing. Treatment include pus drainage
and consumption of antibiotics.(6)
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19. Conclusions
• Anal pain (Proctalgia) can be distressing, but it's often
just the result of a minor, treatable problem.
• Anal pain is a common complaint which can affect
anyone, at any age.
• Anal pain is often goes away on its own. You’ll usually be
able to relieve the pain yourself but if not, your GP will
be able to offer treatment.
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20. References
(1)Sriram Bhat M, “SRB’s Clinical Methods in SURGERY”, 1st edition , India ,New
Delhi: Jaypee Brothers Medical Publishers (P) Ltd , 2010.
(2)John L. Pfenninger, MD, Grant C. Fowler, MD, “PFENNINGER & FOWLER’S
Procedures for Primary Care”, 3rd edition, Philadelphia: Elsevier Inc., 2011.
(3)Nisar Ahmad Chowdri , Fazl Q. Parray, “Benign Anorectal Disorders” : A Guide to
Diagnosis and Management, India : Springer Pvt. Ltd, 2016.
(4)Daniel K. Podolsky MD and others, “Yamada’s Textbook of Gastroenterology” ,
6th edition, UK: John Wiley & Sons, Ltd, 2016.
(5)FRED F. FERRI,” Ferri’s clinical advisor”, Philadelphia : Elsevier, Inc. , 2018.
(6)Norman S. Williams, Christopher J.K. Bulstrode, P. Ronan O'Connell, “Bailey and
Love’s short practice of surgery” , 26 edition, boca raton, US : Taylor and francis
group, 2013. Ministry of Higher Education and Scientific
Research
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