Anorectal Conditions

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ANAL FISSURES

Clinical Description

Painful small cracks just inside the anal margin, sometimes may be present with a linear ulcer. It is often seen with a sentinel pile or external haemorrhoids. 

Clinical Features

SIGNS AND SYMPTOMS

  • May cause spasm of the anal sphincter, and maybe associated with bleeding on defaecation.

Treatment

NON-PHARMACOLOGICAL

  • Dietary advice to promote soft stools

PHARMACOLOGICAL 

Children

  • Lactulose oral 0.5ml/kg/dose daily
    • If no response increase frequency to twice daily.

Adults

  • lactulose, oral, 10-20ml once daily
    • If poor response increase frequency to twice daily
  • Bismuth subgallate compound, ointment, topical, applied 2-4 times daily

Or

  • Lidocaine 2% cream applied before and after each bowel action.

REFERRAL:

  • severe pain
  • recurrent episodes
  • Poor response to symptomatic treatment
  • Persistent anal bleeding

HAEMORRHOIDS

Clinical Description

  • Varicose veins of the anorectal area. Usually accompanied by a history of constipation. In older patients consider a diagnosis of an underlying carcinoma.

Treatment 

NON-PHARMACOLOGICAL 

  • High fiber diet
  • Counsel against chronic use of laxatives
  • Avoid straining with defecation

PHARMACOLOGICAL 

  • (Hydrocortisone acetate, Allantoin, Zinc oxide, Lidocaine) combination suppositories once daily for 2 weeks
  • If no response increase frequency to 2-3 for 2 weeks

REFERRAL:

  • Haemorrhoids cannot be reduced
  • Thrombosed
  • Poor response to symptomatic treatment 
  • Children
  • If Persistent bleeding

PERIANAL ABSCESSES

Clinical Description

An abscess adjacent to the anus. Present as an indurated or tender area adjacent to the anus.

TreatmentThis can be treated by surgical drainage.