Painful anal conditionsDone by : Sara Ali Fatima Abd Alisupervisor : Dr . Muhanad Al-Shareefy
Surgical anatomyThe anal canal commence at the level where the rectum pass through the pelvicdiaphragm and ends at the anal verge.INTERNAL SPHINICTOR: it’s a thickened continuation of circular muscle of rectum.*involuntary , white in color.*long 2.5 cm and thickness 2.5 mm.
EXTERNAL SPHINICTERS: * pink in color * voluntary (somatic innervation)Inter sphincteric plane: * It’s potential space between internal and external sphincteric muscles.*contain 8-12 apocrine glands.
Ano rectal ring :* junction between the anal canal and rectum .*formed by the junction of : **pubo rectalis muscle **deep external sphincter **conjoined longitudinal muscle **highest part of internal sphincter
The dentate linemarks the transition point between autonomic (insensitive), columnar and spinal nerve (sensitive),squamous epithelium.
Painful anal conditionsThere are several conditions that cuases pain in anal region but the most common are* Haemorrhoids * Fissure in ano* peri anal haematoma* peri anal abscess* proctalgia fugax
Haemorrhoids* it means dilated veins in relation to anus.* location at 3,7,11 o’clock in lethatomy position.* haemorrhoids – types in relation to anal orifice: ** internal type. **external type. ** interno external type.
Aetiology :most haemorrhoids are idiopathic but they may be appear secondary to :1. ca colon due to compression to the sup.rectal vein.2. during pregnancy .3. during continuous straining as in B.P.H and urethral structure.4. during chronic constipation.
complications :* profuse haemorrhage – uncommon* ulceration * strangulation * thrombosis * gangrene* fibrosis
Treatment :1. Dietary and lifestyle modification such as (high fiber diet, laxatives,avoidance of straining)2. Medication ( topical and systemic)3.Surgical therapy : *Sclerotherapy *cryosurgery *Rubber band ligation *Photo coagulation * laser haemorrhoidectomy
Anal fissure * elongated tear at anal margin.* Site – midline/post (90% of men ,70% of women)* causes : Hard stool / trauma increased sphincter tone STD other diseases
Types :1.Acute type : characteristic by* pain , sometimes the patient constipated* slight bleeding* slight discharge2.chronic type : characteristic by* inflamed indurated margin * sentinel tag externally
Treatment*conservative initially * local anesthetic ointment with lubricant laxative.* application of GTN cream.* chemical agents (botulinum toxin ).* surgery if above fails ( lateral anal sphincterotomy)
Anal abscess*Infected cavity filled with pus found near to anus*Causative agents -60% E-coli/ 23% Staph aurus.*usually produce painful , throbbing ,swelling in anal region with swinging pyrexia.Treatment Early surgical drainage to prevent rupture and possible formation of fistula.
Perianal haematoma* Is produce by thrombosis within the inferior rectal venous plexus.* usually painful (because it is supplied by somatic nerves )*produces tense, dark blue , cherry size lump at anal margin.* if untreated , this haematoma either subsides over few days leaving fibrous tag or rupture discharging some clotted blood .
Treatment * in acute phase , immediate relief is produced by evacuating the haematoma through a small incision under local anesthesia.*Reassurance and hot baths are prescribed If the patient is seen when the haematoma is discharging or becoming absorbed.
Proctalgia fugaxbenign episodic pain due to rectal muscle spasm.
