This document discusses several painful anal conditions including anal fissures, proctalgia fugax, anorectal abscesses, perianal hematomas, complicated hemorrhoids, and anal cancer. It provides information on the typical causative microorganisms for anorectal abscesses, appropriate treatment options for various conditions which may include drainage, examination under anesthesia, antibiotics in some cases, and surgery. Sitz baths and conservative measures are recommended for treating some hemorrhoids and hematomas.

2. Painful anal
conditions :
Anal fissure
Proctalgia fugax
Anarectal abscess
Perianal heamotoma
Complicated hemorrhoids
Anal cancer
2

6. Microrganism….??
• In 60% of cases , pus from the abscess give pure culture of
E.coli
• 23%...... Pure culture of staph. Aureus.
• Others…… proteus , strept. Or mixed.

7. • fistula-in-ano (most common)
• Crohn’s disesase
• diabetes
• immunosuppression

10. Anorectal abscesses should be treated by drainage as soon as the
diagnosis is established .
an examination under anesthesia is often the most expeditious
way both to confirm the diagnosis and to treat the problem.
Delayed or inadequate treatment may occasionally cause
extensive and life threatening suppuration with massive tissue
necrosis and septicemia

15. Antibiotics are only indicated if there is extensive overlying
cellulitis or if the patient is immunocompromised
Antibiotics alone are ineffective at treating perianal or
perirectal infection.

16. Per i-anal Hematoma
A perianal hematoma is a collection of blood under
the surface of the skin at the edge of the anal
opening.
1.History:
Occurs at all ages.
Male & female  equally affected
The patient often notices that the peri-anal skin is
moist & itchy.
It’s occasionally multiple & may be recurrent.

17. 2.Physical Examination
• Position:
– The lump may be anywhere around the anal
margin
– More than one may present
• Color:
– When the lump is close to the skin and the skin is
not edematous  deep red-purple color
– If the skin becomes edematous  the redness of
the underlying blood clot can’t be seen
• Tenderness:
– The lump is tender  due to tension
– edema & ulceration of the skin ↑ tenderness

18. • Shape & Size:
– The initial lump is spherical & up to 1 cm in
diameter.
– The lump becomes polypoid if the skin is lax or or
becomes edematous.
• Surface:
– Covered by normal r edematous skin
– Smooth surface
• Composition:
– Central lump can be felt as solid, hard,
hemispherical mass.

19. managment
• Acute phase:
– Evacuate the hematoma through a small incision
 under LA
• Discharging or absorbed hematoma  hot
pathes

20. Hemor rhoids
• Painful hemorrhoids are:
– 3rd degree hemorrhoid
Hemorrhoids that prolapse but must be pushed
back in by a finger.
– Thrombosed hemorrhoid (containing blood clots)
– Strangulated hemorrhoid
– Ulcerated hemorrhoid

21. Physical Examination:
Two or three tense, tender, red-purple mucosa
covered swelling protruding from the anal canal
Remember that major piles are at the 3,7 & 11
o’clock positions
The piles that have been prolapsed & thrombosed
for a long time  increase possibility to be
ulcerated& infected they should be
differentiated from prolapsing carcinoma or other
gross pathology

22. managment
• Conservative
• Avoid constipation & ensure bulky stool with increasing fiber content of
the diet.
• Topical preparations containing local anesthetic agents & steroids.
• Thrombosed external hemorrhoids:
• Bed rest.
• Application of ice packs.
• Oral analgesia + topical local anesthetic gel.
• excision of the hemorrhoid or clot evacuation
if the patient presents less than 48 hours
after the onset of symptoms

23. Sitz Bath
• Relaxes anal sphincter
• Decreases
inflammation w/
Epsom® salts
• 10-15 minutes, 3-4
times/day

24. • Anal malignancy is rare and accounts for less than 2% of
all large bowel cancers
• Uncommon tumour, which is usually a squamous cell
carcinoma
• May affect the anal verge or anal canal
• Associated with HPV
• More prevalent in patients with HIV infection
• Lymphatic spread is to the inguinal lymph nodes
• Treatment is by chemoradiotherapy in the first instance
• Major ablative surgery is required if the above fails

25. • mass, bleeding, pain, discharge, itching, and
tenesmus.
• more common in men

26. • Small, well-differentiated lesions ( < 3cm ) are treated by
wide local excision.
• Deep lesions that involve the sphincters require
abdominoperineal resection