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Common perianal conditions

Common perianal conditions. Mr Rowan Collinson FRACS Colorectal and General Surgeon. ‘Outlet-type’ PR bleeding Haemorrhoids Anal fissure Anal fistula Faecal incontinence Pruritis ani. Haemorrhoids Fissure Proctitis. Haemorrhoids: Presentation. Rectal outlet bleeding Lumps

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Common perianal conditions

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  1. Common perianal conditions Mr Rowan Collinson FRACS Colorectal and General Surgeon

  2. ‘Outlet-type’ PR bleeding • Haemorrhoids • Anal fissure • Anal fistula • Faecal incontinence • Pruritis ani

  3. Haemorrhoids • Fissure • Proctitis

  4. Haemorrhoids: Presentation Rectal outlet bleeding Lumps Mucus discharge Itch Difficulty getting clean Pain ‘constipation’ Straining Incomplete evacuation Blockage Faecal incontinence ‘Rectal prolapse’

  5. Risk factors increasing age pregnancy and childbirth Family history Gravity Straining…(really?)

  6. Differential diagnosis • Anal tags • Fibroepithelial polyp • Sentinel pile/Fissure • Rectal mucosal prolapse • Rectal prolapse • Rectal tumour • Dermatitis

  7. Be clear on what is the presenting complaint Encourage conservative measures Tailored approach to surgery

  8. Conservative management • Cochrane review 2008 • beneficial effect of fibre laxatives for improving symptoms • Especially bleeding • The results for other symptoms • prolapse, pain or itching • not as clear

  9. Topical preparations

  10. Little evidence of efficacy • In pregnancy avoid steroid preparations • Short term usage worth a trial

  11. Rubber band ligation

  12. Surgery • Very dependent on symptoms • essential to establish the true presenting complaint. • Excisional haemorrhoidectomy versus Stapled haemorrhoidopexy

  13. Anal fissure

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