‘‘A pain in the backside’A pain in the backside’

Kamal PatelKamal Patel

Anorectal conditions in GPAnorectal conditions in GP

AimsAims– Overview of the anatomyOverview of the anatomy– Common causes of anal pain and mxCommon causes of anal pain and mx– Functional anal painFunctional anal pain

ConsiderationsConsiderations– A common problem.A common problem.– Source of embarrassment for patient (and GP in Source of embarrassment for patient (and GP in

some cases!).some cases!).

AnatomyAnatomy

AnatomyAnatomy

HistoryHistory Age of patient.Age of patient. Duration of symptoms.Duration of symptoms. AssociationsAssociations

– BleedingBleeding– DischargeDischarge

Timing of painTiming of pain– DefacationDefacation– SittingSitting

Related symptomsRelated symptoms– Change of bowel habit.Change of bowel habit.

Sinister featuresSinister features– Weight lossWeight loss

Causes of anorectal painCauses of anorectal pain

OrganicOrganic– Anal fissureAnal fissure– Perianal abscessPerianal abscess– Perianal haematomasPerianal haematomas– CarcinomaCarcinoma– Strangulated haemorrhoidsStrangulated haemorrhoids– Pilonidal sinusPilonidal sinus

FunctionalFunctional– Levator ani syndromeLevator ani syndrome– Proctalgia fugaxProctalgia fugax

Anal fissureAnal fissure

Perianal AbscessPerianal Abscess

Perianal haematomasPerianal haematomas

Pilonidal SinusPilonidal Sinus

Levator ani syndromeLevator ani syndrome

Prevalence 6.6%Prevalence 6.6% More common in women.More common in women. PC: vague ache or pressure in rectum; worse on PC: vague ache or pressure in rectum; worse on

sitting.sitting. Diagnosis of exclusion.Diagnosis of exclusion. Mx:Mx:

– ‘‘digital massage of the levator ani’digital massage of the levator ani’– Sitz bathsSitz baths– Electrogalvanic stimulationElectrogalvanic stimulation– Biofeedback training.Biofeedback training.

Proctalgia FugaxProctalgia Fugax

Severe cramp-like pain in the rectumSevere cramp-like pain in the rectum Short durationShort duration Diagnosis of exclusionDiagnosis of exclusion ‘‘Many patients are perfectionistic, anxious, Many patients are perfectionistic, anxious,

and/or hypochondriacal’and/or hypochondriacal’ Mx – reassurance. ?inhaled salbutamolMx – reassurance. ?inhaled salbutamol