Anal Pain \/\/FREE\\\\
Anal pain is pain that occurs in or around the anus and rectum (the last section of the large intestine that ends in the anus). Pain and bleeding from the rectum often accompany anal pain. People may feel embarrassed to ask their doctor about anal pain, but it is a common symptom of many different medical conditions and is usually easily treated.
Anal pain can occur before, during, or after a bowel movement. It can range from a mild ache that can get worse over time to pain that is bad enough to restrict daily activities. Anal pain has many causes, most of which are common and treatable. However, if anal pain does not go away within 24 to 48 hours, it is important to see your physician. If fever is present with anal pain, a more urgent appointment is needed.
The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but are often confused with other anal conditions, such as hemorrhoids. The goal of all nonsurgical treatments is to make stools soft, formed, and bulky. One should avoid constipation. Treatments include a high-fiber diet, which may include over-the-counter fiber supplements (25-35 grams of fiber/day); over-the-counter stool softeners; warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day; and several types of medication to help ease bowel movements. Increasing the blood supply to the area of the anal fissure is also key to recovery. Topical medications like Nitroglycerin and Nifedipine have proven to be very successful in enhancing blood supply to the affected area and facilitating healing. Although most anal fissures do not require surgery, chronic ones (lasting greater than 6 months) are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscle relax, which reduces pain and spasms, allowing the fissure to heal.The anal canal is a short tube surrounded by muscle at the end of your rectum. The rectum is the bottom section of your colon (large intestine). An anal fissure (also called fissure-in-ano) is a small rip or tear in the lining of the anal canal. Fissures are common, but are often confused with other anal conditions, such as hemorrhoids. The goal of all nonsurgical treatments is to make stools soft, formed, and bulky. Treatments include a high-fiber diet and over-the-counter fiber supplements (25-35 grams of fiber/day); over-the-counter stool softeners; warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day; and several types of medication. Although most anal fissures do not require surgery, chronic ones are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscle relax, which reduces pain and spasms, allowing the fissure to heal.
An abscess is an infected cavity filled with pus near the anus or rectum. In most cases, an abscess is treated by draining it surgically. A fistula is a tunnel that forms under the skin, connecting the clogged, infected glands to the abscess and out to the skin near the anus. Surgery is often needed to cure an anal fistula. Patients with Inflammatory Bowel Disease can also develop abscesses or fistulas. Treatment of the underlying etiology is key for these patients. Sometimes these surgeries are simple; however, more difficult cases may need multiple surgeries to take care of the problem.
Patients with fungal infections or infections caused by sexually transmitted diseases (STDs) may have mild to severe anal or rectal pain. STDs include gonorrhea, chlamydia, herpes, syphilis, HPV, etc. The pain is not always tied to having bowel movements. Other signs may include minor anal bleeding, a discharge, or itching. Treatment includes topical or oral antibiotics and antifungal medications.
Skin disorders that affect other parts of the body (e.g. psoriasis, warts) may also affect skin around the anus. Anal itching, bleeding, and pain may come and go. In some cases, a skin biopsy is needed. Treatment is tied to the results of the skin biopsy and/or physical exam. Early diagnosis is key so treatment can begin as soon as possible.
While most cases of anal pain are not cancer, tumors can cause bleeding, a mass, and changes in bowel habits, as well as pain that gets worse over time. If you have pain or anal bleeding that does not go away or gets worse, see a colon and rectal surgeon as soon as possible. The first office visit includes a physical exam, exam of the anal canal with a small, lighted scope (anoscopy) to visualize any abnormal areas, and biopsy of the mass. If the pain is too bad for an exam in the office, your surgeon may need to perform an exam under anesthesia to make a proper diagnosis. Treatment of anal cancer or other anal tumors may involve chemotherapy, radiation and/or surgery.
It can range from itchy irritation to sharp pain that may be worse during bowel movements. Although most causes of anal pain are harmless, the level of pain can be severe because the anus has a lot of nerve endings.
External hemorrhoids are swollen veins that can form near the anus. They are usually caused by constipation and straining during bowel movements. Sometimes a blood clot can form in them and this can cause dull pain, itchiness, or tingling sensations in the anus. You may feel a painful lump near the anus. They may bleed as well, mainly after bowel movements.
Treatment includes increasing fiber in your diet and using stool softeners to prevent constipation. You can apply over-the-counter steroid creams, such as hydrocortisone, to the hemorrhoid to reduce pain and swelling.
Sexually transmitted infections (STIs), such as chlamydia, gonorrhea, anal warts, and HIV, can cause sharp burning pain in the anus and surrounding areas. This can sometimes cause mucous discharge and bleeding in the area as well. This is more likely to occur in people who are having anal receptive intercourse.
The rectum is a distinct part of the gastrointestinal system. However, people typically describe rectal pain as any pain or discomfort in the anus, rectum, or lower portion of the gastrointestinal (GI) tract.
Anal, colorectal, and colon cancers are usually painless in the beginning. In fact, they may cause no symptoms at all. The first signs of pain or discomfort may come if the tumors grow large enough to push on tissue or an organ.
Chronic anal pain is difficult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifies 3 main diagnostic categories for chronic anal pain: local causes, functional anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests, and main treatments for each condition are reviewed.
Patients in whom medical therapy fails may be candidates for surgical intervention. The timing of intervention depends on the initial response to conservative therapy and on symptom severity. Patients with severe anal pain can be offered surgical intervention if no improvement is seen within a week. Injection of botulinum toxin type A into the internal sphincter can lead to symptomatic relief and healing of some fissures. Overall, it is safe and rarely causes any degree of incontinence. The paralysis that it causes occurs within hours of injection, reaches its peak within a week, and can last between one and three months.8 However, in many patients the relief is temporary and long-term fissure recurrence is common, often making additional injections necessary.8 Furthermore, botulinum is expensive; the cost of 100 units is $558 at our institution. Because of these reasons, we do not offer injection as a sole treatment. However, for a subgroup of patients with fissures refractory to medical therapy who are at risk of incontinence or are reluctant to undergo the gold standard surgical treatment of lateral internal sphincterotomy (LIS), we have combined injection of botulinum with fissurectomy. Debridement of the fibrotic edges of a chronic fissure can stimulate healing when combined with fissurectomy.11 Typically we inject 60 to 80 units of botulinum toxin type A into the internal sphincter muscle; we have seen complete fissure resolution in many patients.
She received 4 cycles of chemotherapy (vincristine and doxorubicin) and 3 months after the last cycle, the patient developed a perianal abscess with perianal swelling and anal pain. The perianal abscess was drained and a colostomy was done to promote wound healing. Post-procedure, despite the healing of the abscess, the pain continued, and it was severe enough to hinder the child's ability to stand or ambulate. Local examinations did not reveal perianal tenderness or myofascial trigger points. The complete blood counts, as well as the renal, liver and coagulation profiles were within normal limits. Ultrasonography and contrast medium-enhanced computed tomography of the abdomen showed no significant findings. The pain was relentless and did not even respond to intravenous administration of paracetamol (200 mg tid), diclofenac (20 mg bid), tramadol injections (20 mg bid), and local lignocaine jelly application. Only a continuous intravenous fentanyl infusion (10 µg/kg/h) gave her 50% relief in pain, and the cause of pain was not known.
After the ganglion impar block the child had complete pain relief, and fentanyl infusion was stopped. On the 2nd day, when the patient was reassessed, she could sit and walk without pain. One week later the child was discharged from the hospital, and tablet paracetamol 250 mg was advised on an as-and-when-needed basis. At one month follow up she was pain free without any analgesics.
The ganglion impar, is a singular retroperitoneal structure located at the level of the sacro-coccygeal junction. Blocking it is useful in patients who suffer from pain in the pelvic and perineal structures as it provides nociceptive and sympathetic supply to this region . The ganglion impar block is a well established procedure for the treatment of coccydynia , but its role in the treatment of anal pain with varied aetiologies is not well studied. In our case, the ganglion impar block hit the pain pathway's bullseye, and we were able to relieve the patient's unbearable discomfort. 041b061a72