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Other Conditions

Anorectal problems such as rectal or anal cancer, fissures, fistulae, abscesses, hematomas or puritus ani have similar symptoms and may be incorrectly referred to as hemorrhoids (also haemorrhoids or piles). The symptoms of these conditions are often also reduced by treatments intended to combat hemorrhoids.

However, the consequences of improper or delayed treatment for some of these conditions (such as cancer) can be serious, and a consultation with your doctor, or other qualified professional, is strongly recommended to confirm the correct diagnosis, especially when the symptoms are first encountered.

Anal Abscess

Also rectal, perirectal, anorectal and perianal abscess.

This is a large pocket of infection (abscess) adjacent to the anus. Pain may be limited and sporadic at first, but invariably becomes worse over just a few days to a constant pain that can be severe when body position is changed and/or during defecation (depending on the precise location of the abscess). An anal abscess is often an indication of an underlying condition, such as Crohn’s disease. If an abscess is left untreated, the infection can spread to other parts of the body.

An anal abscess is often initially misdiagnosed by the patient as a bad case of hemorrhoids, but the speed of worsening and ineffectiveness of normal hemorrhoid treatments indicate the presence of an abscess.

Treatment requires surgery to drain the abscess, often followed by a course of antibiotics appropriate to the species of bacteria that caused the infection.

Anal Fissure

This is a crack or tear in the skin of the anus. The fissure may bleed and cause severe pain during and after defecation. Many fissures heal themselves, but some become chronic and will not heal, often due to spasm of the sphincter muscles that causes poor blood flow to the area, resulting in an ulcer.

Anal fissures are caused by stretching of the skin beyond its natural capability, and are therefore common after childbirth, excessive anal intercourse, difficult bowel movements and in infants following constipation.

Anal Fistula

This is an abnormal connection between the inner surface of the anal canal and the external skin. An anal fistula is caused by the blockage of an anal gland that results in the formation of an abscess that eventually reaches the skin surface. Anal fistulae are generally not harmful in themselves, but can be painful and irritating from the drainage of pus. They can also be prone to infection.

Acute abscesses usually require surgery, and the fistula itself can also be repaired by surgery, although this is generally not considered essential. Abscess formation can be minimized by keeping the fistula open by means of a drainage seton (length of suture material inserted into the fistula) that allows pus to drain out.

Puritus Ani

This is irritation and itching of the skin around the anus, often caused by chemicals in foods such as spices, hot sauces and peppers; coffee, tea; carbonated beverages; milk products; cheese; tomatoes and tomato products such as ketchup; chocolate; nuts. Can also be caused by irritation from frequent liquid stools, diarrhea or incontinence. Yeast infection (candidiasis, or thrush) is another major cause.

Treatment is usually directed toward relief of the burning and soreness. The anus should be cleaned and dried thoroughly, for example by gentle showering without direct rubbing with either washcloth or towel. Take care to avoid leaving soap in the anal area. Moist pads instead of toilet paper should be used for cleaning the anus after defecation.

Many over-the-counter products are also available, such as ointments, creams, gels, suppositories, foams and pads. These often contain the same drugs that are used for treating hemorrhoids. They usually include some form of anesthetic to help relieve the pain, burning and itching, and nearly all include a protectant that forms a physical barrier on the surface of the skin to prevent contact with the aggravating material.

Ointments, creams and gels should be applied as a thin covering around the anus, and can be applied to the anal canal by insertion of a finger or ‘pile pipe’. Pile pipes are most efficient when they have holes in the sides as well as at the end, and should be lubricated with ointment prior to insertion. Suppositories and foams do not have advantages over ointments, creams and gels – their use is largely a matter of personal preference.

For persistent anal itching, efforts should be directed towards identifying the underlying cause, then removing it, for example by adjustment of diet, treatment of infections, or surgical procedures.

Perianal Hematoma

This is a type of hematoma located in, or on the border of, the anus. It is caused by the rupture of a small vein that drains blood from the anus, possibly by heavy lifting, coughing or straining. Blood from the rupture pools in the skin within a few hours, and if left untreated forms a clot. Pain (mild to severe) results from the expansion of the skin due to the pressure of the blood, and usually continues after the blood has clotted, for up to 2–4 days. If left untreated, the clot will eventually dissolve back into the bloodstream and the hematoma will disappear, possibly leaving behind a skin tag that may cause annoyance or irritation.

If caught early, before the blood has clotted, the blood can be removed using a syringe. Otherwise the clot can be removed thorough a simple incision under local anesthetic.

Rectal Cancer

Rectal cancer, more precisely colorectal cancer and also known as colon or large bowel cancer, is the third most common form of cancer, and the second leading cause of cancer-related death in the Western world. It can sometimes give rise to symptoms similar to internal hemorrhoids, such as rectal bleeding, especially if the tumor has grown large and is located close to the anus. Other symptoms include loss of appetite and weight loss; anemia resulting in dizziness, fatigue and palpitations; change in frequency of defecation; feeling of incomplete defecation and reduction in diameter of stool; and bowel obstruction causing bowel pain, bloating and even vomiting of stool-like material.

If left untreated, the cancer is likely to spread to other parts of the body, such as the bladder, vagina and liver. Early diagnosis is important for successful treatment, which usually involves surgery to remove the tumor, possibly followed by chemotherapy and/or radiotherapy.

Anal Cancer

Anal cancer is very rare but the symptoms can be very similar to hemorrhoids, including itching, bleeding, pain or lumps in the anal area. Treatment is similar to other forms of cancer: radiation, chemotherapy and surgery.

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