Anorectal disorders: Difference between revisions

Revision as of 20:30, 6 January 2026

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Background

Anatomy of the anus and rectum.

Anatomy of the anus.

The interior of the anal cami and lower part of the rectum, showing the anal columns and the anal valves between their lower ends (columns in image numerous than typical).

Coronal section of rectum and the anal canal.

Clinical Features

Visual Diagnosis

Differential Diagnosis

Anorectal Disorders

Anal fissure
Anal fistula
Anal malignancy
Anal tags
Anorectal abscess
Coccydynia
Colorectal malignancy
Condyloma acuminata
Constipation
Crohn's disease
Cryptitis
GC/Chlamydia
Fecal impaction
Hemorrhoids
- Internal hemorrhoid
- External hemorrhoid
Levator ani syndrome
Pedunculated polyp
Pilonidal cyst
Proctalgia fugax
Proctitis
Pruritus ani
- Enterobius (pinworms)
Rectal foreign body
Rectal prolapse
Syphilitic fissure

Non-GI Look-a-Likes

Prostatitis

Evaluation

Algorithmic Diagnostic Approach

Pain
- Bleeding
  - External hemorrhoid
  - Prolapsed internal hemorrhoid
  - Anal Fissure
    - Off midline = cancer, HIV, TB, Crohn's
- No bleeding
  - Swelling
    - Anorectal abscess
      - Perirectal
      - Ischiorectal
      - Intersphincteric
      - Supralevator
    - Pilonidal cyst
    - Anal fistula
    - Hidradenitis suppurativa
  - No swelling
    - Proctalgia fugax
No pain
- Bleeding
  - Cancer
  - Internal hemorrhoid
- Swelling
  - Itch: Condyloma acuminata
  - No itch: Rectal prolapse
- Itching
  - Discharge: Proctitis
  - No discharge: Pruritus Ani

Management

Disposition

External Links

References

Authors:

@@ Line 1: / Line 1: @@
-==Diagnosis==
+<languages/>
+<translate>
+==Background== <!--T:1-->
-===Pain and Bleeding===
+<!--T:2-->
+[[File:Rectum anatomy en.png|thumb|Anatomy of the anus and rectum.]]
+[[File:Human anus-en.png|thumb|Anatomy of the anus.]]
+[[File:Gray1080.png|thumb|The interior of the anal cami and lower part of the rectum, showing the anal columns and the anal valves between their lower ends (columns in image numerous than typical).]]
+[[File:Gray1078.png|thumb|Coronal section of rectum and the anal canal.]]
-)  external hemorrhoids
+==Clinical Features== <!--T:3-->
-     -swelling
-     -looks like skin if not thrombosed
+==Visual Diagnosis== <!--T:4-->
-     -12,7,9 o'clock
+<!--T:5-->
+<gallery mode="packed">
+File:PMC2653786 ijmsv06p0077g13.png|[[Special:MyLanguage/Anal tags|Anal tags]]
+File:DSCB4096(anal worms or just toilet paper remainders@).jpg|[[Special:MyLanguage/Enterobius|Enterobius]] (pinworms)
+File:M 44 anus 22.jpg|[[Special:MyLanguage/External hemorrhoid|External hemorrhoid]]
+File:Anal fissure 2.jpg|[[Special:MyLanguage/Anal fissure|Anal fissure]]
+File:SOA-Condylomata-acuminata-around-anus.jpg|[[Special:MyLanguage/Anal warts|Anal warts]]
+File:Perianalabscess.jpg|[[Special:MyLanguage/Perianal abscess|Perianal abscess]]
+File:Hemrrhoids 05.jpg|[[Special:MyLanguage/Internal hemorrhoid|Internal hemorrhoid]] with prolapse
+File:Pilonidal abscess.jpg|[[Special:MyLanguage/Pilonidal cyst|Pilonidal cyst]]
+File:Full thickness rectal prolapse & mucosal prolapse..jpg|[[Special:MyLanguage/Rectal prolapse|Rectal prolapse]]
+</gallery>
-)  anal fissure
-     -no swelling
+==Differential Diagnosis== <!--T:6-->
-     -off midline = CA, HIV, TB, Crohn's
+</translate>
+{{Anorectal DDX}}
+<translate>
-)  prolapsed internal
+==Evaluation== <!--T:7-->
-===Pain, No Bleeding===
+===Algorithmic Diagnostic Approach=== <!--T:8-->
-) swelling
+<!--T:9-->
+*Pain
+**Bleeding
+***External [[Special:MyLanguage/hemorrhoid|hemorrhoid]]
+***Prolapsed internal [[Special:MyLanguage/hemorrhoid|hemorrhoid]]
+***[[Special:MyLanguage/Anal Fissure|Anal Fissure]]
+****Off midline = cancer, [[Special:MyLanguage/HIV|HIV]], [[Special:MyLanguage/TB|TB]], [[Special:MyLanguage/Crohn's|Crohn's]]
+**No bleeding
+***Swelling
+****[[Special:MyLanguage/Anorectal abscess|Anorectal abscess]]
+*****Perirectal
+*****Ischiorectal
+*****Intersphincteric
+*****Supralevator
+****[[Special:MyLanguage/Pilonidal cyst|Pilonidal cyst]]
+****[[Special:MyLanguage/Anal fistula|Anal fistula]]
+****Hidradenitis suppurativa
+***No swelling
+****[[Special:MyLanguage/Proctalgia fugax|Proctalgia fugax]]
+*No pain
+**Bleeding
+***Cancer
+***Internal [[Special:MyLanguage/hemorrhoid|hemorrhoid]]
+**Swelling
+***Itch: [[Special:MyLanguage/Condyloma acuminata|Condyloma acuminata]]
+***No itch: [[Special:MyLanguage/Rectal prolapse|Rectal prolapse]]
+**Itching
+***Discharge: [[Special:MyLanguage/Proctitis|Proctitis]]
+***No discharge: [[Special:MyLanguage/Pruritus Ani|Pruritus Ani]]
-     a. abscess
-          i. perirectal
-          ii. ischiorectal
-          iii. intersphincteric
+==Management== <!--T:10-->
-          iv. supralevator
-     b. pilonidal (drain off midline)
+==Disposition== <!--T:11-->
-     c. fistula (2/2 chronic abscess; don't probe)
-     d. hidradenitis suppurativa
+==See Also== <!--T:12-->
-) no swelling
+<!--T:13-->
+*[[Special:MyLanguage/Diagnoses by Body Part (Main)|Diagnoses by Body Part (Main)]]
-     a. proctalgia fugax
-         -episodic pain (women, pts < 45yo)
+==External Links== <!--T:14-->
-     b. incontinence
-         -urgency
+==References== <!--T:15-->
-===Bleeding, No Pain===
-) CA
-) internal hemorrhoids
-===Painless Swelling===
-) itch --> condyloma acuminata (warts 2/2 HPV)
-) no itch --> procidentia (rectal prolaps; peds - think CF, malnutrion)
-===Itching===
-) discharge --> proctitis (inflamm changes of rectum within 15cm of dentate line; GC/chlamy, HSV)
-) 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
+==References== <!--T:16-->
+<!--T:17-->
+<references/>
+<!--T:18-->
 [[Category:GI]]
+[[Category:Symptoms]]
+</translate>