Four common ailments responsible for anal pain
by LUKE T. CHANNER, M.D. - Hamilton General Surgery
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People are often reluctant to bare their derriere to physicians when anal pain arises due to embarrassment. The patient’s history of anal pain and rectal bleeding often make diagnosing the problem easy. There are four common anal ailments that most physicians see in their practices. These include external thrombosed hemorrhoids, internal hemorrhoids, anal fissures, and perirectal abscesses.
Hemorrhoids are dilated veins of the anal canal that expand under pressure during a bowel movement or labor. Internal hemorrhoids often present with painless bright red blood dripping into the toilet after a bowel movement or staining on the toilet paper. At times internal hemorrhoids can prolapse and require manual reduction by the patient. Straining to have a bowel movement and leisure reading on the toilet exacerbate internal hemorrhoids. Patients can initially manage internal hemorrhoids conservatively with daily stool softeners and fiber supplements. Hemorrhoids that do not respond to conservative management are treated by a variety of methods. The most common method is an office procedure in which a rubber band is placed at the base of the hemorrhoid. In advanced cases, the patient is taken to the operating room where a larger amount of tissue can be removed.
External hemorrhoids are characterized by a sudden onset of a painful lump at the anal opening. They are clotted veins and appear purple in color upon examination. The pain is intense for the first 2-3 days and then it starts to taper off. If a patient is seen in the first 2-3 days, the clotted external hemorrhoid is removed under local anesthetic in the office. Without surgical treatment, the clot will gradually reabsorb and no further medical treatment is needed.
Anal fissures typically cause severe anal pain which starts during a bowel movement and lasts for several hours. A fissure is a crack in the anal mucosa similar to a paper cut. Each bowel movement causes the anal fissure to open up followed by intense pain and possibly a small amount of bright red blood. Conservative management with stool softeners and fiber is initially required. Second line treatment is applying daily lidocaine ointment and nitroglycerin ointment to the fissure. Lastly, some fissures will heal if Botox is injected around the fissure. Chronic anal fissures that don’t respond to conservative measures are treated with a surgical procedure that partially cuts the anal sphincter muscle.
Perirectal abscesses are extremely painful and most patients are unable to sit down due to the pain. Patients often report it feels like they are sitting on a hot potato. Abscesses begin as a result of an infection in the anal glands. They are drained in the office under local anesthetic and require some wound care until completely healed.
Don’t assume you have one of these four common anal ailments without consulting your family doctor. Colon cancer can also mimic any of these four anal ailments. A colonoscopy is considered in the workup of patients with rectal bleeding.
Questions or comments can be addressed to Luke T. Channer, MD, c/o Hamilton General Surgery, 1150 Westwood Drive, Ste D, Hamilton, MT 59840.
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