Anorectal disorders

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.

Visual Diagnosis

• 

  Anal tags

• 

  Enterobius (pinworms)

• 

  External hemorrhoid

• 

  Anal fissure

• 

  Anal warts

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  Perianal abscess

• 

  Internal hemorrhoid with prolapse

• 

  Pilonidal cyst

• 

  Rectal prolapse

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

See Also

• Diagnoses by Body Part (Main)