‘A pain in the backside’ Kamal Patel. Anorectal conditions in GP Aims –Overview of the...
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Transcript of ‘A pain in the backside’ Kamal Patel. Anorectal conditions in GP Aims –Overview of the...
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‘‘A pain in the backside’A pain in the backside’
Kamal PatelKamal Patel
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Anorectal conditions in GPAnorectal conditions in GP
AimsAims– Overview of the anatomyOverview of the anatomy– Common causes of anal pain and mxCommon causes of anal pain and mx– Functional anal painFunctional anal pain
ConsiderationsConsiderations– A common problem.A common problem.– Source of embarrassment for patient (and GP in Source of embarrassment for patient (and GP in
some cases!).some cases!).
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AnatomyAnatomy
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HistoryHistory Age of patient.Age of patient. Duration of symptoms.Duration of symptoms. AssociationsAssociations
– BleedingBleeding– DischargeDischarge
Timing of painTiming of pain– DefacationDefacation– SittingSitting
Related symptomsRelated symptoms– Change of bowel habit.Change of bowel habit.
Sinister featuresSinister features– Weight lossWeight loss
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Causes of anorectal painCauses of anorectal pain
OrganicOrganic– Anal fissureAnal fissure– Perianal abscessPerianal abscess– Perianal haematomasPerianal haematomas– CarcinomaCarcinoma– Strangulated haemorrhoidsStrangulated haemorrhoids– Pilonidal sinusPilonidal sinus
FunctionalFunctional– Levator ani syndromeLevator ani syndrome– Proctalgia fugaxProctalgia fugax
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Anal fissureAnal fissure
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Perianal AbscessPerianal Abscess
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Perianal haematomasPerianal haematomas
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Pilonidal SinusPilonidal Sinus
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Levator ani syndromeLevator ani syndrome
Prevalence 6.6%Prevalence 6.6% More common in women.More common in women. PC: vague ache or pressure in rectum; worse on PC: vague ache or pressure in rectum; worse on
sitting.sitting. Diagnosis of exclusion.Diagnosis of exclusion. Mx:Mx:
– ‘‘digital massage of the levator ani’digital massage of the levator ani’– Sitz bathsSitz baths– Electrogalvanic stimulationElectrogalvanic stimulation– Biofeedback training.Biofeedback training.
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Proctalgia FugaxProctalgia Fugax
Severe cramp-like pain in the rectumSevere cramp-like pain in the rectum Short durationShort duration Diagnosis of exclusionDiagnosis of exclusion ‘‘Many patients are perfectionistic, anxious, Many patients are perfectionistic, anxious,
and/or hypochondriacal’and/or hypochondriacal’ Mx – reassurance. ?inhaled salbutamolMx – reassurance. ?inhaled salbutamol