Anorectal disorders

Diagnosis

Pain and Bleeding

1) external hemorrhoids

    -swelling

    -looks like skin if not thrombosed

    -12,7,9 o'clock

2) anal fissure

    -no swelling

    -off midline = CA, HIV, TB, Crohn's

3) prolapsed internal

Pain, No Bleeding

1) swelling

    a. abscess

         i. perirectal

         ii. ischiorectal

         iii. intersphincteric

         iv. supralevator

    b. pilonidal (drain off midline)

    c. fistula (2/2 chronic abscess; don't probe)

    d. hidradenitis suppurativa

2) no swelling

    a. proctalgia fugax

        -episodic pain (women, pts < 45yo)

    b. incontinence

        -urgency

Bleeding, No Pain

1) CA

2) internal hemorrhoids

Painless Swelling

1) itch --> condyloma acuminata (warts 2/2 HPV)

2) no itch --> procidentia (rectal prolaps; peds - think CF, malnutrion)

Itching

1) discharge --> proctitis (inflamm changes of rectum within 15cm of dentate line; GC/chlamy, HSV)

2) no discharge --> pruritis ani (pinworms)

External Hemorroid Excision

<48 hrs

• All pts presenting with anorectal complaints should be considered for HIV testing

Anorectal Emergencies Algorithm.pdf

Source

Donaldson; adapted from Coates