Painful anal conditions by zaid

1. By: Zaid Rasheed Younis
Superviser: Dr. Moafiq
University of duhok
College of medicine

2. 2
Painful anal conditions
Anal fissure
Anarectal abscess
Perianal heamotoma
Complicated hemorrhoids
Anal cancer

3. - Infection of anal glands (90%)
• In 60% of cases caused by E.coli
23% due to staph. Aureus.
- Extension of cutaneous boil
- Blood born infction
- Rectal CA.
- crohn’s dis.
Predisposing factor: D.M. AIDS

6. Clinical features :
-all ages
-More common in male
-Sever anal pain (throbbing) aggravated by
walking,straining&coughing.(2-3 days)
- examination
1-pyrexia
2-Tender round cystic lump at anal verge
3-urinary retension(rare)
Clinical features similar to perianal abscess

8. 1-draining pus …C/S
2- biopsy to the wall of cavity to
exclude specific cause

10. A)Drainage
B)Antibiotics are only indicated
1-if there is extensiveoverlying cellulitis
2- if the patient is immunocompromised
Antibiotics alone are ineffective at
treating perianalor perirectal infection.

11. Idefinition : s a longitudinal split (ulcer) in
the anoderm of the distal anal canal
Location :90% midline posterior
Aetiology
-during defecation ..pressure of hard fecal
mass …post. anal tissue (unsupported by
muscle )----tear.
-recent …..ischemia
-Other causes :
posthaemorrhoidectomy..Infl. bowel dis.,
sexually trans. dis.
Anal Fissure

12. Clinical features
Symptoms:
Pain: sharp agonizing
Constipation
Bleeding slight bright streaks on the stool
Mucous Discharge and itching
On exam.:
Sentinel tag(external lump associated with the tear,
as well as extra tissue just inside the anal canal)
Longituidinal Ulcer

13. Treatment
Conservative treat.:
Laxatives e.g celevac tab
Anal dilatation
Nitric oxide
Diltiazim 2% twice daily.
Botulin toxin (paralysis of anal sphincter)
Surgical management : if conservative treatment failed

14. Peri-anal Hematoma
A perianal hematoma is a collection of blood under
the surface of the skin at the edge of the anal
opening.

15. 2.Physical Examination
• Position: The lump may be anywhere around the anal margin
• Color: deep red-purple color
• Tenderness: The lump is tender due to tension
– edema & ulceration of the skin  ↑ tenderness
Shape & Size:The initial lump is spherical & up to 1 cm in
diameter.
1.History:
- peri-anal skin is moist & itchy.
-It ’s occasionally multiple & may berecurrent.

17. managment
• Acute phase:
– Evacuate the hematoma through a small incision
under LA
• Discharging or absorbed hematoma  hot
pathes

18. Hemorrhoids
• Painful hemorrhoids are:
– 3rddegree hemorrhoid
Hemorrhoids that prolapse but must be pushed
back in by a finger.
– Thrombosed hemorrhoid (containing blood clots)
– Strangulated hemorrhoid
– Ulcerated hemorrhoid

19. managment
• Conservative
• Avoid constipation
• increase fiber content of the diet to ensure bulky stool with .
• Topical preparations containing local anesthetic agents & steroids.
•
Thrombosed external hemorrhoids:
•
•
•
•
Bed rest.
Application of ice packs.
Oral analgesia + topical local anesthetic gel.
excision of the hemorrhoid or clot evacuation
if the patient presents less than 48 hours
after the onset of symptoms

20. • Anal malignancy is rare and accounts for less than 2% of
all large bowel cancers
• which is usually a squamous cell carcinoma
• Associated with HPV
• More prevalent in patients with HIV infection
• Lymphatic spread is to the inguinal lymph nodes
• Treatment is by chemoradiotherapy in the first instance
• Major ablative surgery is required if the above fails

21. • mass, bleeding, pain, discharge, itching, and
tenesmus.
• more common in men

22. • Small, well-differentiated lesions ( < 3cm ) are treated by
wide local excision.
• Deep lesions that involve the sphincters require
abdominoperineal resection