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Anal Problems. First 15cm on rigid sigmoidoscopy Levator ani Internal sphincter (autonomic) External sphincter (voluntary) Vascular cushions. Anal Canal. Upper Superior rectal a&v (inf. mesenteric) Inf. mesenteric lymph. autonomic Lower Inferior rectal a&v (internal iliac)

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anal problems

Anal Problems

First 15cm on rigid sigmoidoscopy

Levator ani

Internal sphincter

(autonomic)

External sphincter

(voluntary)

Vascular cushions

anal canal
Anal Canal
  • Upper
    • Superior rectal a&v

(inf. mesenteric)

    • Inf. mesenteric lymph.
    • autonomic
  • Lower
    • Inferior rectal a&v

(internal iliac)

    • Superf. inguinal lymph.
    • somatic
haemorrhoids
Haemorrhoids
  • Symptoms and Signs
    • Bright red rectal bleeding,

prolapse, mucus, pruritis ani,

pain on thrombosis, anaemia

  • Management
    • Exclude other causes of bleeding
    • Conservative, Sclerotherapy, Banding, Haemorrhoidectomy
fistula in ano
Fistula in Ano
  • Symptoms and Signs
    • Initial abscess with discharge

recurrent perianal infection

and persistent discharge

  • Management
    • Examination under anaesthetic
    • Superficial and low-level fistulae laid open
    • High fistulae – low part laid open, upper part tied with seton
perianal haematoma
Perianal Haematoma
  • Symptoms and Sign
    • Tense, smooth, dark blue, cherry-sized lump at anal margin
    • Acute onset, sudden pain
  • Management
    • Drainage under local anaesthetic
    • Hot baths
perianal abscess
Perianal Abscess
  • Symptoms and Signs
    • Painful, tender perianal swelling

with discharge

  • Management
    • Examination under anaesthetic, MRI, US
    • Surgical incision and drainage
    • Antibiotics
perianal warts
Perianal Warts
  • Symptoms and Signs
    • Cornified epithelial lesions

often in clusters

    • Discomfort, pain, pruritis ani
  • Management
    • Most resolve spontaneously (2 years)
    • Silver nitrate / podophyllin
    • Curettage
anal carcinoma
Anal Carcinoma
  • Symptoms and Signs
    • Anal verge – palpable mass,

pain, bleeding, discharge,

pruritis ani

    • Anal sphincter – incontinence
  • Management
    • EUA, sigmoidoscopy, biopsy
    • Early – radiotherapy (inc. inguinal lymphatics)
    • Late – surgery, colostomy
rectal prolapse
Rectal Prolapse
  • Symptoms and Signs
    • Discomfort, bleeding and mucus on defecation, tenesmus, incontinence, protrusion
  • Management
    • Conservative
    • Surgical
problems in childhood
Problems in Childhood
  • Imperforate anus (with fistulation)
    • 1/5000 new-born infants, especially males
  • Partial rectal prolapse
    • Confined to the mucosa, self-curing
  • Congenital megacolon /Hirschprung disease
    • Absent distal autonomic ganglion cells in myenteric plexus