Surgical Conditions of the Rectum and Anus

by / Tuesday, 03 August 2010 / Published in Surgery

Surgical Conditions of the Rectum and Anus

Hemorrhoids

  • Varicosities of the hemorrhoidal plexus
  • Often related to strenuous bowel movements

Signs and Symptoms:

  • Bright red blood per rectum
  • Itching
  • Burning
  • Palpable anal mass
  • Internal hemorrhoids are NOT painful, while external hemorrhoids ARE painful

Treatment:

  • Usually self-limiting
  • Sitz bath
  • Hemorrhoidal cream
  • Stool softeners to relieve pain

Thrombosed Hemorrhoids

  • These are not a true hemorrhoid, but are external hemorrhoidal veins of the anal canal
  • They are a painful bluish elevation that lie beneath the skin

Classifications:

  • 1° hemorrhoids involve no prolapse
  • 2°  hemorrhoids classically prolapse with defecation but return without manual reduction
  • 3°  hemorrhoids prolapse with either straining or defecation and require manual reduction
  • 4°  hemorrhoids are not capable of being reduced

Treatment:

  • Conservative therapies
  • Sclerotherapy, rubber band ligation, and surgical hemorrhoidectomy

Anal Fissure

  • A crack or tear in the anal canal
  • Usually occurs after the passage of diarrhea or constipation

Signs and Symptoms:

  • The most common presentation is the passage of a painful bowel movement that is accompanied by bright red blood

Diagnosis:

  • Perform an anoscopy to diagnose

Treatment:

  • Bulking agents and stool softeners are usually all that is needed
  • If fissures persist despite conservative measurements, a lateral internal sphincterotomy may be required

Anal and Rectal Cancer

Anal Cancer:

  • The most common form is squamous cell carcinoma

Signs and Symptoms:

  • Anal bleeding, pain, and mucus upon evacuation

Diagnose:

  • Biopsy

Treatment:

  • Chemotherapy + Radiation

Rectal Cancer:

  • Seen in males > females

Signs and Symptoms:

  • Rectal bleeding, altered bowel habits, tenesmus, obstruction

Diagnosis:

  • Colonoscopy

Treatment:

  • Surgery that spares the sphincter
  • If metastasis involved, addition of 5-FU chemotherapy + radiation

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