ANAL AND PERJANAL PROBLEMS

I. Anal Fissure

1. Due to split at the junction of the perianal skin and the anoderm (lining of the lower third of the anal canal), most common in children and young adults.
2. Severe pain with defecation lasting up to 30 minutes after, and may be associated with bright red (“anal canal”) bleeding.
3. Examination reveals the split of the fissure mostly mid-line posteriorly, and an associated sentinel pile.

Haemorrhoids See Chapter on ‘Haemorrhoids’.

Ill. Perianal abscess

1. Follows infection of one of the anal glands or the perianal skin. The former might lead to an anal flstula later.
2. There is constant throbbing pain unrelated to defecation.
3. Examination reveals a classic indurated red, very tender swelling in the penanal or ischiorectal region.
4. Fluctuate swelling above the level of levator ani should alert to possibility of intersphincteric abscess, and calls for examination under anaesthesia.

Treatment Surgical drainage.

IV. Proctalgia Fugax

1. Severe recurrent perianal, anal or rectal pain lasting up to 30 minutes at a time.
2. Usually in young men, and could be after sexual intercourse, or in association with erection.
3. Clinically no abnormality is made out.
4. Treatment Tends to regress spontaneously in later life. Internal sphincterotomy is performed in some on the premise that this is a disorder of the internal sphincter.

V.  Coccydynia

1. Mainly a disease of women between 40-55 years, with burning pain radiating to coccyx, sacrum, buttocks and thighs, and aggravated by sitting down.

No abnormality is seen on examination. Treatment Only reassurance. Any other cause to be excluded