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June 2010

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Anorectal pain, bleeding and lumps

Volume 39, No.6, June 2010 Pages 376-381

W John Daniel

Background

The patient presenting with anal pain, anal lump or rectal bleeding is a common occurrence in the general practice setting and the combination of symptoms usually gives an indication of the most likely diagnosis. However, careful examination including digital rectal examination is always required.

Objective/s

This article discusses three common anorectal conditions: perianal haematoma, haemorrhoids and anal fissure, and briefly discusses the less common, but not to be missed conditions: anal carcinoma and low rectal carcinoma.

Discussion

The majority of first degree haemorrhoids can be managed by conservative measures alone. More severe degree haemorrhoids require surgical intervention with sclerosant injection, rubber band ligation or surgical haemorrhoidectomy. Initial treatment for anal fissure is with a high fibre diet, faecal softeners, topical local anaesthetic gel and glycerol trinitrate ointment. Botulinim toxin can be injected to create a chemical sphincterotomy, allowing healing. Chronic fissures produce intense and constant pain in the anal region and in these cases surgical sphincterotomy is often necessary to cure the condition, but can result in faecal incontinence. Anal cancer has similar presentation to haemorrhoids and carcinoma of distal rectum can initially present with a haemorrhoid, so the possibility of anorectal cancer should be considered in any patient presenting with haemorrhoids, tenesmus and change in bowel habit.

Anorectal problems are frequent presentations in the general practice setting.1 Symptoms tend to be a combination of one or more of pain, lumps, bleeding, discharge or itch. In this article we focus on pain, lumps and bleeding. (Perinanal itch is discussed in the article by MacLean and Russell in this issue).

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Correspondence afp@racgp.org.au

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