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‘A pain in the backside’ Kamal Patel. Anorectal conditions in GP  Aims –Overview of the anatomy –Common causes of anal pain and mx –Functional anal pain.

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Presentation on theme: "‘A pain in the backside’ Kamal Patel. Anorectal conditions in GP  Aims –Overview of the anatomy –Common causes of anal pain and mx –Functional anal pain."— Presentation transcript:

1 ‘A pain in the backside’ Kamal Patel

2 Anorectal conditions in GP  Aims –Overview of the anatomy –Common causes of anal pain and mx –Functional anal pain  Considerations –A common problem. –Source of embarrassment for patient (and GP in some cases!).

3 Anatomy

4 Anatomy

5 History  Age of patient.  Duration of symptoms.  Associations –Bleeding –Discharge  Timing of pain –Defacation –Sitting  Related symptoms –Change of bowel habit.  Sinister features –Weight loss

6 Causes of anorectal pain  Organic –Anal fissure –Perianal abscess –Perianal haematomas –Carcinoma –Strangulated haemorrhoids –Pilonidal sinus  Functional –Levator ani syndrome –Proctalgia fugax

7 Anal fissure

8 Perianal Abscess

9 Perianal haematomas

10 Pilonidal Sinus

11 Levator ani syndrome  Prevalence 6.6%  More common in women.  PC: vague ache or pressure in rectum; worse on sitting.  Diagnosis of exclusion.  Mx: –‘digital massage of the levator ani’ –Sitz baths –Electrogalvanic stimulation –Biofeedback training.

12 Proctalgia Fugax  Severe cramp-like pain in the rectum  Short duration  Diagnosis of exclusion  ‘Many patients are perfectionistic, anxious, and/or hypochondriacal’  Mx – reassurance. ?inhaled salbutamol


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