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GTN versus placebo

This study evaluates the effectiveness of GTN (glyceryl trinitrate) compared to a placebo in the treatment of anal fistula/abscess and faecal incontinence. It also explores the causes and management of pruritus ani (anal itching) and provides helpful tips for prevention.

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GTN versus placebo

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  1. GTN versus placebo

  2. GTN versus Botox

  3. Anal fistula/abscess

  4. Faecal incontinence 1 stool 2 rectum 3 sphincters 4 local reflexes 5 descending control 5 1 2 4 3

  5. Faecal incontinence • 3 L’s • Loperamide • Low fibre diet • ‘levator’ exercises

  6. Pruritis ani

  7. symptom complex • intense itch and burning discomfort of the perianal skin • frequently associated with varying degrees of skin breakdown, weeping, maceration, lichenification, and superinfection

  8. Primary Secondary personal hygiene anatomic compromise diarrheal states radiation psychological gynaecologic conditions diet systemic disease drugs dermatologic conditions infections neoplasms Aetiology

  9. Diet • may represent the most significant cause of secondary pruritus ani • may cause symptoms due to • consistency of the stool • direct irritation by components of the diet • watery stools if an excessive volume of liquid is consumed

  10. many with diet-induced PA relate their symptoms to ingestion of coffee or dairy products • Coffee • apparent threshold of 2 - 4 cups per day • Milk • arises at the ingestion of 6 - 10 oz daily • Chocolate, tea, and cola • ?due to the xanthine content • nonabsorbed, oily food additive • e.g. Olestra, a fat substitute

  11. Jaundice cholestyramine may help Chronic renal failure cause of the itching is unclear UVB radiation is the most successful treatment Diabetes mellitus vulvar and anogenital pruritus frequent association of the disease with candidiasis Other iron deficiency usually resolves with replacement thyrotoxicosis or myxedema predisposed to generalized pruritus Hodgkin's disease polycythemia vera reportedly aggravated by bathing and showering with warm water ?symptoms are related to elevated blood histamine levels. antihistamines or antiserotonin medications are often effective Systemic Diseases

  12. Drugs • cause PA through both contact irritation and increased leakage of faecal material • Quinidine and colchicine • Tetracycline • topical ointments, creams, or cleansing agents • scented soaps, deodorants, coloured toilet tissues, and laundry detergents • contain chemicals such as formaldehyde, alcohol, perfumes, and astringents • alcohol-based anal wipes

  13. Viral/bacterial infections • Mycoses/candidiasis • Parasites • Pinworms (Enterobius vermicularis) • Scabies • Pediculosis pubis (crab or louse) • Neoplasms

  14. Avoid creams and ointments Avoid soaps Dry well Wear cotton Use soft but strong toilet paper Avoid excessive cleaning Sweating problem Take care of your diet Dry skin Avoid scratching

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