Anal conditions

Proctology is the treatment of diseases relating to the colon, rectum and anus. Your colon is your large intestine, your rectum is the final section of your large intestine and your anus is the opening at the end of your rectum through which solid waste leaves your body as poo.

Diseases and disorders of this part of your digestive system can very often be successfully treated.

Rectal Bleeding (Due to Haemorrhoids)

About Haemorrhoids

Also called piles – are clumps of enlarged blood vessels in the anus and lower rectum. They can be caused by straining to open the bowel or due to increased pressure on the veins during pregnancy. Internal haemorrhoids develop inside the rectum, whereas external haemorrhoids develop under the skin around the anus.

Symptoms

Sometimes there are no symptoms but at other times haemorrhoids can cause itching, discomfort and bleeding.

Straining to open the bowel can sometimes push an internal haemorrhoid out through your anus. This is known as a protruding or prolapsed haemorrhoid. It can cause pain and irritation.

Thrombosed haemorrhoids occur when blood pools in an external haemorrhoid causing a clot. These can be very painful, causing swelling and inflammation.

Who might be at risk?

Haemorrhoids are very common – estimates suggest that almost three out of four adults will develop them at some time in their lives.

Risk factors include:

  • Pregnancy
  • Obesity
  • Straining to open the bowel

They are not normally dangerous although rarely they can cause anaemia if there is chronic blood loss.

You should see a doctor if haemorrhoids start to cause bleeding, especially if you are over 40. This bleeding may actually be a sign of other more serious conditions, including colorectal cancer.

Investigations for Diagnosis may include:

Common Methods of Treatment

Most haemorrhoids can be treated effectively with over-the-counter remedies and lifestyle changes, such as eating more fibre. If you experience rectal bleeding, your doctor will carry out tests to rule out more serious conditions.

Non-surgical

  • Over-the-counter medications
  • Lifestyle changes
  • Changes in defecatory dynamics
  • Banding

Surgical

  • THD
  • Ligasure haemorrhoidectomy
  • Formal haemorrhoidectomy
FAQs
Rectal Bleeding (Due to Haemorrhoids)

An anal fissure, which is a small tear in the skin of the anus, can cause a burning or gnawing pain that can go on for several hours after you’ve been to the toilet. In some cases, you may experience a severe, sharp pain when you poo or notice a small amount of blood when you wipe your bottom.

Haemorrhoids or piles can cause a lump in or around your anus that can become sore or itchy. If the blood supply to the haemorrhoid becomes blocked, for example by a blood clot, your bottom can become very painful.

A condition called proctalgia fungax can lead to episodes of sudden, severe anal pain. Your doctor can prescribe medication to relax the muscles in the pelvis if this diagnosis is confirmed.

Rectal Bleeding (Due to Fissure)

About

An anal fissure is a tear or ulcer that develops in the anus.

Symptoms

  • Pain when you open the bowel, which may be followed by a burning sensation that can last for several hours
  • Bleeding when you open the bowel

Who might be at risk?

Anal fissures are common and tend to occur when someone has constipation, causing large or hard poos, which can tear the lining of the anal canal.

They are also linked to Inflammatory Bowel Disease, pregnancy and childbirth, persistent diarrhoea and some sexually transmitted infections.

Common Methods of Treatment

Treatment for anal fissures includes:

Non-surgical

  • Lifestyle changes – improving fibre and fluid intake
  • Diltiazem ointment

Surgical

  • Botox injections
  • Advancement flaps – selected patients only
  • Lateral spincterotomy – only for selected patients due to the risk of incontinence
FAQ's
Rectal Bleeding Due to Fissure FAQs

A fissure is a narrow tear from the muscles of the anus up into the anal canal. It can be caused by passing particularly large or hard poos. An anal fistula is a tubelike passage that runs from a hole in the skin near the anus up into the anal canal. It can occur after anal surgery or an abscess.

An anal fissure will normally heal within four to six weeks with home treatment. Pain when you go for a poo should be reduced within a few days. You should try to avoid becoming constipated while the fissure heals by eating plenty of fibre-rich foods and drinking water. Some fissures will not heal despite home treatment and these are referred to as chronic fissures.

It depends on the severity of the fissure. Your GP will normally recommend home treatment first. However, if the fissure persists and becomes chronic you may require surgery to repair it.

Anal Warts

About

Genital warts (including anal warts) are a sexually transmitted infection that can be passed on through vaginal, anal and sometimes oral sex. They are caused by the Human Papilloma Virus.

Symptoms

Anal warts affect the area around and inside the anus. They start off small but can grow up to several inches in length. In most cases they don’t cause pain or discomfort although they might itch and bleed if they grow large enough.

Who might be at risk?

You are at risk if you have a sexual partner with genital warts, or if you share sex toys with someone who has them.

If you are pregnant, talk to your midwife as they can rarely be passed from mother to baby at birth.

Common Methods of Treatment

Treatment for anal warts includes:

Non-surgical
Imiquimod

Surgical
Surgery to cut or burn the warts off

FAQ's
Anal Warts

You normally get genital warts (including anal warts) by coming into contact with someone who is infected. Warts can remain dormant in someone’s system for up to six months so they can be passed on to others without the carrier realising. You can also get them by sharing sex toys or towels.

Unfortunately not. Anal warts will remain until you have an effective course of treatment to get rid of them. There are surgical and non-surgical treatments depending on the severity of the problem.

Genital and anal warts can vary in colour from pink to purple, white or grey. They start off small but can grow to up to half an inch in length. They tend to appear in clusters and may resemble a cauliflower.

Anal Pain

About

Anal pain – proctalgia – is normally the result of a minor condition that can be easily treated. It refers to any pain in and around the anus or rectum.

Symptoms

Pain is the symptom of a number of possible conditions, including:

  • Anal fissure
  • Haemorrhoids
  • Anal fistula or abscess
  • Less common conditions, such as Proctalgia Fugax. Levator Ani Syndrome or Inflammatory Bowel Disease

Who might be at risk?

You might be at risk if you have any of the conditions listed above, and also urinary tract infections and bone-related problems such as Coccydynia and bone tumours.

Common Methods of Treatment

Treatment for anal pain depends on the causes, which a GP or consultant will diagnose. Some treatments include:

Non-surgical

  • Biofeedback therapy
  • Diltiazem ointment
  • Botox injections
  • Medications such as amitriptyline
  • Relaxation techniques
FAQ's
Anal Pain

An anal fissure, which is a small tear in the skin of the anus, can cause a burning or gnawing pain that can go on for several hours after you’ve been to the toilet. In some cases, you may experience a severe, sharp pain when you poo or notice a small amount of blood when you wipe your bottom.

Haemorrhoids or piles can cause a lump in or around your anus that can become sore or itchy. If the blood supply to the haemorrhoid becomes blocked, for example by a blood clot, your bottom can become very painful.

A condition called proctalgia fungax can lead to episodes of sudden, severe anal pain. Your doctor can prescribe medication to relax the muscles in the pelvis if this diagnosis is confirmed.

Pruritus Ani

About

Pruritus Ani is an itchy bottom. There can be a number of causes, including:

  • Haemorrhoids
  • Threadworms
  • Diarrhoea or incontinence
  • Fungal infection
  • Genital warts
  • Some medications

Symptoms

The symptoms are itching, which can be worse at night (normally indicating threadworms).

Who might be at risk?

Any of the conditions listed above can cause an itchy bottom. It is rare for it to be a sign of anything more serious but sometimes it can be linked to anal or bowel cancer so talk to your doctor if you are worried or it doesn’t have an obvious cause.

Common Methods of Treatment

Treatment for Pruritus Ani includes:

  • Hygiene improvements
  • Steroid cream
  • Antihistamine
  • Emollient cream in place of soap
FAQ's
Pruritus Ani

The condition can be made worse by heat, moisture around the anus which may be caused by sweating or incomplete drying after washing, poo coming into contact with the skin around the anus, stress and anxiety. Be careful to wipe your bottom thoroughly after going to the toilet and always dry yourself properly after washing. Try to avoid scratching the itch which can make it worse.

It is believed that up to five in every 100 people may suffer from an itchy bottom. The condition is more common in men than women and most often affects people between the ages of 40 and 60. However, anyone can be affected, including children.

Certain foods when they are not fully digested are known to irritate the skin around the anus when you go for a poo. These include: citrus fruit, grapes, tomatoes, spices and chilli, milk, beer and caffeine. There are lot of other potential causes too so it is a good idea to talk to your doctor to try and identify the root cause.

Abscess

About

An abscess is a collection of pus, usually caused by a bacterial infection. Abscesses can develop anywhere in the body and are usually very painful. They can also develop inside the body – in an organ or the space between organs.

Symptoms

An abscess appears as a painful, swollen, pus-filled lump. You may also develop a high temperature and symptoms of fever. An internal abscess can cause pain in the affected area and a high temperature.

Who might be at risk?

Most abscesses are caused by bacteria getting into a minor wound, such as a hair follicle or blocked sweat gland.

Risk factors include:

  • Poor hygiene, including not washing hands properly
  • Poor diet
  • Being overweight
  • Smoking

Common Methods of Treatment

A large abscess may need to be treated with antibiotics or drained with a needle. In some cases they may require surgery.

FAQ's
Abscess

A perirectal abscess is a collection of pus in the deep tissues around the rectum. A perianal abscess is shallower, occurring just under the skin surrounding the anus. Both may be referred to as an anal abscess.

An anal abscess requires immediate medical attention. Delaying treatment can cause the condition to deteriorate and may lead to complications.

Some medical conditions can increase the likelihood of developing an anal abscess. These include: diabetes, Crohn’s Disease, HIV or AIDS, cancer; sexually transmitted disease; pregnancy; or any kind of condition that is treated with medications that suppress the body’s immune system, such as steroids.

Fistula

About

An anal fistula is an abnormal tunnel that runs from a hole in the skin near the anus up into the anal canal.

Symptoms

The infection causes pus to collect. Symptoms include:

  • Swelling, redness and a constant, throbbing pain that may be worse when you sit down
  • Passing pus or blood when you open the bowel
  • A high temperature (fever)

Who might be at risk?

One in every two to four people with an anal abscess go on to develop a fistula. They can occur if the abscess doesn’t heal properly after the pus has drained away. They can also be linked to Crohn’s Disease, Diverticulitis, Hidradenitis Suppurative and TB or HIV.

Common Methods of Treatment

Treatments for fistula include:

Surgical

  • Seton
  • LIFT proceduren
  • Mucosal advancement flaps
  • Fistula lay-open
FAQ's
Fistula

Anal fistulas need to treated because they will not heal by themselves and there is a very small risk of developing cancer in the fistula tract if they are left untreated for long periods

If left untreated, fistulas can become chronic but it is extremely unlikely this would lead to serious complications although further abscess will occur.

A fistula can cause bleeding and discharge when you go for a poo and can be painful.

Pilondial disease

About

Pilondial Disease is a chronic skin infection in the crease between the buttocks that causes cysts that can become inflamed and infected. A pilonidal cyst may resemble a dimple – sometimes referred to as a sinus.

Symptoms

The condition does not always cause symptoms unless it becomes infected in which case there may be pain, swelling and a possible abscess.

Who might be at risk?

The condition can be caused by hair between the buttocks being pushed inwards. Men tend to be more prone to it than women as they are generally hairier. It can also occur in people who sit for long periods of time.

Common Methods of Treatment

Treatments for Pilondial Disease include:

Surgical

  • Excision and primary closure
FAQ's
Pilondial Disease

Pilonidal cysts normally occur either when:

  • a hair follicle becomes irritated or stretched, which may occur during certain types of exercise such as horse riding or cycling
  • a loose hair gets trapped in the crease between the buttocks
  • you are born with them.

Your doctor will carry out a physical examination.

Keep the area dry and clean and try not to sit on hard surfaces for extended periods. If the cyst becomes infected, soak it in warm water several times a day and use antibacterial soap or an alcohol swab to clean the area if your doctor instructs you to do so. You can take over the counter painkillers if necessary.

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