Anorectal pain

"How many embarrassed middle aged gentlemen does it take to change a lightbulb..."

Definition

A right royal pain in the arse.

Epidemiology

Pretty common, especially if you work in GP 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

Differential Diagnosis

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.