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A right royal pain in the arse.
EpidemiologyGP or A&E.
Clinical and Associated Features
Obviously the biggest symptom is pain.
Accompanying it can be:
- Blood in stool
- Change in bowel habit
- Abdominal pain
- Abdominal distension
- Weight loss
- Diarrhoea or constipation
Systemic, serious or common.
- Haemorrhoids - often accompanied with feeling of "grapes" out of the bum, with fresh blood on the toilet paper when wiping. Can be linked to portal hypertension.
- Crohn's disease - can cause pain or discomfort.
- Cancer - especially when accompanied by blood or weight loss.
- Rectal prolapse - occurs in older people, where the rectum comes out the bum. At first it is retractable, then less and less so.
- Trauma - sometimes from anal sex, or from embarrassing A&E admissions to remove foreign bodies.
Local skin damage
- Fistulae - common in Crohn's, new channels in skin.
- Anal fissure - split in the anal skin.
- Pilonidal sinus/abscess - infected spots or swellings.
- Perianal abscess - abscess in the skin near the anus.
- Proctalgia fugax - is a severe, episodic, rectal and sacrococcygeal pain. Caused by cramp of the pubococcygeus or levator ani muscles.