What is Anorectal

Anorectal refers to anal or rectum-related conditions. These conditions are mainly caused in the anus and rectum region by some kind of overgrowth or abnormal tissue growth. While it may be humiliating to discuss these issues, dealing with them can be difficult.

The common problems with the anorectal process are:

1. Anal fissures
2. Pilonidal Cyst
3. Perianal Abscess
4. Anal Fistula
5. Hemorrhoids
6. Anal Pain

Anal fissures

Anal fissures are very common, and initially appear as an acute tear in the mucosal lining of the anal canal below the dentate line. Often precipitated by a hard bowel movement or diarrhea, patients complain of intense pain associated with defecation and bright red blood on the toilet paper.

Symptoms and Treatment

Anal fissures typically cause pain and bleeding with bowel. Patients may also experience spasms in the ring of muscle at the end of the anal sphincter. Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.

Pilonidal Cyst

Following the onset of puberty, sex hormones affect the pilosebaceous glands, and subsequently, hair follicles can become plugged up with keratin. Folliculitis can result producing edema and follicle occlusion. If the infected follicle extends and ruptures into the subcutaneous tissue, a pilonidal abscess forms.This results in a sinus tract leading to a deep, subcutaneous cavity. Loose hairs become entrapped within the sinus by friction and movement of the patients buttocks (when sitting or standing), inciting a foreign body reaction and infection. The incidence of pilonidal disease is 2-4 times more likely in men than in women. Hair characteristics such as kinking, coarseness, and growth rate have been studied in their relation to incidence. Other factors including increased sweating, poor personal hygiene, and obesity have been linked to an increased risk.

Treatment

Most often, pilonidal disease can be managed surgically in the ambulatory setting. Surgically, a pilonidal abscess is treated as any type of abscess. Incision, drainage, and curettage of the abscess cavity is the primary management goal. Good personal hygiene and close hair shaving in the area will help prevent contamination of the healing wound. Most wounds heal within 4 weeks, although the meticulous cleansing process should be done for at least 3 months.

For patients with pilonidal disease which persists despite minimal surgery, the surgical options for management include excision with primary closure, excision and laying open of the tract to heal by secondary intention, wide and deep excision to the sacrum, and incision with marsupialization. Each has their own advantages and disadvantages and should be tailored to the patient.

Perianal Abscess

A perianal abscess is a collection of pus near the anus. Blocked perianal glands, infection of an anal fissure, or sexually transmitted infections, and are all thought to be inciting factors. The abscess usually begins when bacteria enters through a tear in the lining of the rectum or anus. Most often, this occurs between the internal and external sphincters (intersphincteric abscess), where the perianal glands are located. As the abscess increases in size, most will follow the plane of least resistance and spread towards the surface, creating a perianal abscess. Occasionally, the infection can spread into the ischiorectal fossa or above the level of the levator muscles, creating ischiorectal and/or supralevator abscesses, respectively. Although supralevator abscesses are difficult to diagnose, perianal and ischiorectal abscesses still seem to account for the majority of the ones encountered.

Treatment

As for virtually any abscess, the primary treatment is prompt incision and drainage of the abscess. Depending on its location, the procedure may take place in an outpatient setting. Deeper abscesses may require surgery with appropriate anesthesia. The expectations following treatment is very good, particularly with prompt treatment. Complications include anal fistula formation, recurrence, scarring and systemic infection in severe cases.

Anal Fistula

Anal fistula is the medical term for an infected tunnel that develops between the skin and the muscular opening at the end of the digestive tract (anus). Most anal fistulas are the result of an infection that starts in an anal gland. This infection results in an abscess that drains spontaneously or is drained surgically through the skin next to the anus. The fistula then forms a tunnel under the skin and connects with the infected gland.

Treatment

Surgery to treat anal fistula may need several steps, starting the a drainage procedure and if the fistula persists, it may require total removal of the fistula tract, called a Fistulectomy.

Hemorrhoids

Hemorrhoids are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids have a number of causes, although often the cause is unknown. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids).

Symptoms

Hemorrhoids are very common. Nearly three out of four adults will have hemorrhoids from time to time. Sometimes they don't cause symptoms but at other times they cause itching, discomfort and bleeding. Occasionally, a clot may form in a hemorrhoid. These can be extremely painful and sometimes need to be lanced and drained.

• Painless bleeding during bowel movements
• You might notice small amounts of bright red blood on your toilet tissue or in the toilet
• Itching or irritation in your anal region
• Pain or discomfort
• Swelling around your anus
• A lump near your anus, which may be sensitive or painful

Treatment

Several effective options are available to treat hemorrhoids. Many people can get relief from symptoms with home treatments and lifestyle changes.

What are the Complications from Hemorrhoids ?

Rarely, chronic blood loss from hemorrhoids may cause anemia. If the blood supply to an internal hemorrhoid is cut off, the hemorrhoid may be "strangulated," another cause of extreme pain, and could ensue a severe infection.

Anal Pain

Oftentimes, the cause of anal pain is not clear or readily evident. This mandates a thorough exam under anesthesia which may also include proctosigmoid.