Help the development of the site, sharing the article with friends!

Anus (Latin anus) is an opening at the end of the digestive tract. Ailments related to the anus - rectal itching, pain in the anus or hemorrhoids, are often underestimated and hidden by patients, both from family and doctors. And this is a serious mistake - if detected earlier, they are usually easier to treat. How is the anus structured and what are its functions? What are the diseases of the anus?

Anal(Latinanus ), like any other part of the digestive system, can cause many ailments, but due to its location and patients, both young and old, often do not talk about them.

Patients seek specialist advice in advanced stages of the disease, when they are unable to cope with troublesome ailments on their own, which make their daily life difficult and significantly reduce their comfort.

In many cases, it is the stage of the disease that determines whether it will be necessary to undergo surgery or if the symptoms can be reduced with the help of conservative treatment and pharmacotherapy.

That is why it is so important not to underestimate the problem and go to a doctor's appointment after any disturbing symptoms appear.

Anal structure

The anal canal is a section of the digestive tract about 3-4 cm long. There are two main muscles within it:

  • internal anal sphincter muscle , made of smooth muscles, acting independently of the human will - tension and resting pressure in the anal canal depend on its efficient operation, therefore it is a key role in holding the stool
  • the external anal sphincter muscle , is made of a circular striated muscle, which is under human control and works at will

Rectal functions

The rectum, anal canal, and anus are the final segment of the human gastrointestinal tract. The anus, thanks to its structure, allows you to maintain and pass stool at will, as well as stop the passing of gases.

Diseases of the anus: symptoms

The most frequently reported symptoms by patients related to anal disorders can be divided into two categories, one being defecation disorders and the other local symptoms.

Amongproblems with defecation are distinguished by:

  • fecal incontinence
  • chronic constipation (these can be caused by a slow intestinal transit, as well as an abnormal function of the anus itself and pelvic floor muscles)

Local complaints include:

  • pain around the anus, which is constantly present during or after a bowel movement
  • soft tissue swelling
  • bleeding

These symptoms often worry patients and are a common reason for their GP follow-up.

Diseases of the anus: diagnosis

A patient who notices changes or experiences troublesome ailments from the anus often decides to see a primary care physician quickly.

After listening to the patient and getting to know his concerns, the doctor will proceed to a physical examination.

It involves a careful examination of the perineal area and a rectal finger examination.

To perform such an examination, the patient should lie on his left side or assume a knee-elbow position.

The evaluation includes, among other things, the length of the anal canal, the muscle tone of the anal sphincters and the contents of the intestine.

The proctological examination allows for the assessment of changes occurring only about 7-8 cm from the edge of the anus.

In order to view the intestinal mucosa and take histopathological specimens of suspected cancerous tissues, an anoscopy should be performed (the examination consists in viewing the end of the rectum with the help of a speculum) or sigmoidoscopy (it is an endoscopic examination that allows you to view approximately 60 cm of the final section of the intestine) with an endoscope).

Diseases of the anus can also be diagnosed using ultrasound, specifically endosonography. With the use of a special rotary head, it is possible to evaluate not only the tissues and organs in the anal area, but also the structure and function of the anal sphincter muscles.

A doctor who suspects cancer in the anus will order specialized imaging tests, including computed tomography (CT) and magnetic resonance imaging (MRI).

They allow not only the assessment of the advancement of the disease, but also the exclusion or confirmation of the presence of local and regional lymph nodes metastases.

Imaging diagnosis is an important factor in determining the prognosis and making decisions about further surgical, pharmacological or radiological treatment of the patient.

Diseases of the anus: fecal incontinence

Stool incontinence is bothersome and embarrassingan ailment that significantly reduces everyday functioning in society and reduces the quality of life.

Faecal incontinence is most commonly seen in:

  • elderly people - it is described that as many as 60% of the elderly have such a problem
  • people with mechanical damage to the anal sphincter muscles as a result of an injury (e.g. after childbirth) or after surgery in this area
  • people with anal sphincter dysfunction caused, for example, by diseases of the nervous system, such as spinal cord injury, spinal injury, multiple sclerosis, as well as the development of tumors located within the spinal cord or sacrum
  • people complaining of dysesthesia and rectal compliance
  • people suffering from rectal prolapse, hemorrhoids, inflammatory bowel diseases, or neoplastic diseases infiltrating the anal sphincter

There are two main treatments for fecal incontinence: conservative treatment and surgical treatment:

  • preventing diarrhea by using substances that improve the consistency of fecal masses
  • in people suffering from neurological diseases, a specialized electrode can be placed in the area of ​​the sacrum, the task of which is to stimulate the nerves of the sacral part of the spinal cord
  • a surgical procedure to reconstruct the anal sphincter muscles or to create a substitute sphincter using the patient's own tissues

Anal varices - hemorrhoids (hemorrhoidal disease, hemorrhoids)

Hemorrhoids, i.e. anal varices, are protrusions, extensions of the venous plexuses around the anus. It is worth noting that these are not varicose veins (as in varicose veins of the lower extremities), but protruding anal pads.

Correctly structured venous plexuses, not dilated, are present from birth and play an important role - they support the closure of the anal canal.

There are internal (congenital) and external haemorrhoids.

Hemorrhoidal disease can be diagnosed when the nodules are swollen, enlarged and dislocated in relation to the anus edge.

Hemorrhoidal disease is a very common, possibly the most common anal disease. It is estimated that over half of the population complains of ailments due to haemorrhoids at least once in their life. They are much more common in people over 50.

  • Causes of haemorrhoids

The factors that influence the formation of hemorrhoids include conditions that cause blood stagnation invenous plexuses, obstruct its outflow and lead to the accumulation and coagulation of blood within the vessel. After the onset of hemorrhoidal disease, they predispose:

  • chronic constipation that causes increased pressure in the rectal cup
  • effort to pass stool
  • low-residual and high-fat diet, which predisposes to constipation and difficulties in defecation
  • sedentary lifestyle
  • pregnancy, which predisposes to the development of hemorrhoids due to the relaxing effect of hormones on the connective tissue, the occurrence of constipation and pressure on the pelvic tissue of the child's head
  • chronic cough
  • Symptoms of hemorrhoidal disease

Physiologically, hemorrhoids occur in every human being and do not cause any symptoms by themselves. Symptoms only appear when the blood remaining in the venous plexuses coagulates.

This will enlarge their dimensions and move them relative to the edge of the anus during defecation. Patients most often report to their doctor because they observe a small amount of bright red blood on the toilet paper after passing stools.

Anal varicose veins may also be accompanied by itching and burning pain in the area of ​​the anus, which intensifies after defecation.

Hemorrhoidal disease is a chronic disease, which does not mean, however, that it cannot cause acute complications, such as thrombosis within protruding varicose veins or massive hemorrhage that requires the intervention of a surgeon in a hospital setting.

  • Diagnosis of hemorrhoidal disease

The appearance of a bright red line of blood on the toilet paper usually causes anxiety among patients and is the reason for contacting the family doctor. After reading the patient's history and listening to the reported complaints, the doctor should examine the patient.

The examination consists in a thorough examination of the anus area and per rectal examination. Despite the diagnosis of haemorrhoids, the patient should be referred for an endoscopic examination (rectoscopy, sigmoidoscopy or colonoscopy) to exclude a neoplastic process that may occur in the large intestine.

  • Treatment of hemorrhoids

Treatment of haemorrhoids depends largely on their size and the severity of the disease on the Parks scale. There are conservative and surgical treatment of hemorrhoids.
Conservative and symptomatic treatment:

  • constipation prevention
  • intestinal passage is accelerated in physically active people, therefore people suffering fromchronic constipation it is recommended to change a sedentary lifestyle
  • burning pain and itching around the anus is very uncomfortable for patients, so it is recommended to use agents that local anesthetics, have anti-inflammatory and astringent properties - these include suppositories, rectal ointments, cool compresses and sitting baths in oak bark decoction or chamomile
  • patients complaining of hemorrhoids should take special care of the hygiene of the anus and wash themselves after each bowel movement

Treatment treatment:

  • bandage of haemorrhoids is a procedure that is performed in a doctor's office. It consists in visualizing the hemorrhage in the anoscopy and using a specialized apparatus, thanks to which it is possible to put a tightening band on the tumor. The rubber restricts the blood flow through the dilated venous plexus, causes ischemia and necrosis of the varicose vein, which spontaneously falls off after 7-10 days.
  • obliteration of haemorrhoids is a treatment method used when conservative treatment does not bring any effect
  • freezing (cryotherapy) of hemorrhoids
  • infrared photocoagulation

Surgical treatment:
Surgical treatment is introduced in the presence of troublesome hemorrhoids, 3rd and 4th grade on the Park's scale, which are not amenable to other treatment methods or the effects of conservative and operative therapy are not satisfactory.

Always bear in mind that hemorrhoidal pillows are physiologically involved in controlling stool and gas holding, and incontinence is a common complication of anal surgeries.

Perianal abscess

An abscess located near the anus is a reservoir of purulent contents, sharply demarcated from the surrounding tissues. The disease is 3 times more common in men than in women.

  • Causes of abscesses

An anal abscess is caused by bacterial infection of the crypts (sinuses) and the anal glands or skin. Over time, the accumulating purulent content finds an outlet and breaks through from the outside, creating a perianal fistula into the anal canal or onto the skin. The most common pathogens causing abscesses include bacteria from the large intestine, such as E.coli, Bacteroides, faecal streptococcus, or staphylococci originating from the skin surface. It is worth noting that recurrent anal abscesses may be the first symptom of a chronic inflammatory bowel disease such as Crohn's disease.

  • Anal abscess: symptoms

The main complaints reported by patients include:

  • intense pain in the anal area, especially when sitting down and expelling
  • swelling, redness and warmth of soft tissues
  • discharge of pus from the anus
  • fever and chills
  • Perianal abscess: examinations

A painful, hardened lesion is palpable on digital rectal examination. The thickening is quite sharply demarcated from the surrounding soft tissues, and after pressing it, purulent contents appear at the mouth of the rectal fistula.

  • Classification of anal area abscesses

Anal abscesses are divided into anal sphincter and levator ani muscles into anal, intersphincteric, ischio-rectal and supraphorectal abscesses. The vast majority, i.e. about 60-70% of abscesses, are purulent, anal reservoirs.

  • Treatment of anal abscesses

Anal abscesses are treated surgically. After local anesthesia, the skin is cut above the pus reservoir, which allows the abscess to empty. For optimal treatment, it is imperative to drain with a filter. As a rule, the doctor does not decide to start antibiotic therapy, and surgical treatment is sufficient.

  • Complications of anal abscesses

The most common complications of perianal abscesses include perianal fistulas, i.e. abnormal connections between the abscess and the anal canal or skin, through which the pus that accumulates inside the lesion escapes.

  • Rectal abscess and anal fistula

Anal fistula

An anal fistula is an abnormal connection between the anal canal and the skin. It is a narrow canal, straight or bifurcated, with granulation tissue through which purulent or fecal contents enter the skin surface. The mouth of the fistula is usually located near the anus, but cases have been reported in which openings were located on the buttocks, above the coccyx, and also in the groin.

  • Causes of fistulas

Anal fistulas most often occur as a complication of perianal abscesses, but they are also observed in the course of chronic inflammatory bowel diseases (e.g. Crohn's disease, ulcerative colitis) or neoplastic diseases. They can also be a complication of surgical treatment of gynecological diseases, as well as those carried out around the anus.

  • Symptoms of anal fistula

To the main symptoms reported bypatients, the primary care physician is burning pain in the anal area and the discharge of purulent or fecal content from the opening in the skin. Patients also complain of itching around the anus and a feeling of discomfort.

  • Anal fistula diagnosis

During rectal palpation, the doctor can feel the fistula canal and locate its internal opening. In order to examine the exact course and structure of the fistula canal, an anoscopic examination is performed with the simultaneous administration of the dye through its external opening. The doctor may also decide to perform an imaging test such as fistulography. It consists in administering a contrast agent through the external opening to the fistula canal, and then taking an X-ray image (X-ray).

  • Anal fistula classification

Perianal fistulas are divided according to their course in relation to the external anal sphincter. There are intersphincteric, transsphincteric, supra-sphincteric and extra-sphincteric fistulae. In medical practice, intersphincteric fistula is most often observed.

  • Anal fistula treatment

Anal fistulas are treated surgically, and the type and extent of the procedure depends on the course of the fistula canal. Treatment consists of surgical excision of the fistula (fistulectomy) or its dissection and leaving it to heal (fistulotomy). It is important to find and close or remove the fistula gates.

Anal fissure

An anal fissure is a narrow, longitudinal fracture of the anal canal mucosa. In many patients, it is accompanied by a sentinel lump, i.e. the outer fold of the skin. It is located in the lowest part of the rift.

There are a posterior and anterior fissure, depending on the location of the fracture relative to the anus. Mucosal defect in the midline of the posterior anal canal is much more often described. The changes may be acute or chronic.

  • Anal fissure: occurrence

Anal fissure is a disease that mainly affects young people aged 20-30, slightly more often reported in men than in women.

  • Anal fissure: causes

The cause of anal fissures is unknown, but it is believed that their formation is influenced by constipation and mechanical injuries to the anus, which occur during increased pressure.

A sharp anal fissure occurs suddenly during a single bowel movement and the passing of a hard stool.

Chronic anal fissure (according to the literature it is a minimum ulcer6 weeks) is a result of superinfection and persistent inflammation in the anus.

  • Anal fissure: symptoms

The main complaints reported by patients include sharp, stabbing, burning pain that occurs during bowel movements and lasts up to several hours after defecation, as well as anal itching and rectal bleeding.

After defecating, patients often see traces of vivid red blood on toilet paper or underwear. Moreover, many patients report experiencing the so-called wet anus, which is caused by a large amount of mucous discharge.

  • Anal fissure: research

Recognizing an anal fissure often involves carefully examining and touching the perianal area to visualize a mucosal defect. Digital rectal examination should be performed, but if an anal fissure is present, it is painful and distressing for the patient and is most often done after initial local treatment has been started.

  • Anal fissure: treatment

Treatment of an anal fissure involves the introduction of conservative and symptomatic therapy, and in extremely troublesome cases, also surgical. Acute fissures, unlike chronic fissures, usually heal spontaneously.

The goal of treatment is to reduce the tension in the anal sphincter muscles, which should facilitate healing of the fissure. Among the medical recommendations, the following are distinguished:

  • constipation prevention, diet rich in fiber, active lifestyle.
  • use of stool softeners.
  • use of topical medications, which include anesthetics, painkillers and astringents, anti-inflammatory drugs, glucocorticosteroids.
  • use of suppositories to reduce the tension of the internal anal sphincter and ointment applied to the anal canal with nitroglycerin and lidocaine (the so-called chemical sphincterotomy, the method of anal fissure treatment of choice).
  • injecting botulinum toxin into the internal anal sphincter muscle to reduce its tension.
  • surgical treatment consisting in cutting a fissure and cutting the internal anal sphincter muscle. It is introduced in the case of long-term conservative treatment, which does not bring the expected results and does not bring relief to the patient. It should be remembered that any surgical treatment may be associated with the occurrence of complications, e.g. incontinence of liquid or solid stool and gases, which occur in approximately 10% of patients qualified fortreatment and significantly reduce the comfort of human life.

Anal itching

Anal itching is an unpleasant, bothersome condition that can occur for many reasons. These include mainly skin diseases, allergies to hygiene products or washing detergents, mycosis, insufficient body hygiene, obesity, diabetes, allergies, anal cancer, haemorrhoidal disease, and parasitic diseases, the most common of which, especially in children, is pinworm.

  • Anal pruritus: treatment

Treatment is usually a combination of therapy for the underlying condition and symptomatic therapy for troublesome pruritus. Thorough hygiene of the perineum and anus is recommended, as well as wearing cotton, airy underwear. Long-lasting skin lesions that do not respond to treatment should be assessed by a specialist dermatologist who will decide on further diagnostics and therapy.

Rectal prolapse, rectal prolapse

Rectal prolapse is a condition in which the rectal mucosa has spread beyond the external sphincter muscle.

Prolapse of the anus most often occurs as a result of the reduction of the tension in the myofascial system of the pelvic floor.

They are observed in women after numerous natural births, people complaining of chronic cough, as well as chronic constipation and difficulties in passing stools. Moreover, numerous neurological diseases predispose to the occurrence of rectal prolapse.

Symptoms of rectal prolapse reported by patients to their physicians vary depending on the severity of the disease. Initially, only the anal mucosa falls outside the anal sphincter during defecation. At this stage, the patient is able to escort her on his own.

A serious problem begins when the entire rectum falls out, and a bright red formation appears around the anus that cannot be drained by hand.
The only method of treating prolapse of the anus and rectum is to perform a surgical procedure that involves sewing the lowering rectum to the sacrum.

Genital warts

Condylomas are soft, multiple growths in the genital area, perineum and anus, skin-colored (from pink to brown).

Initially small warts take more and more surface over time and increase in size, eventually reaching a cauliflower-like shape.

They cause a reduction in the quality of life, pain and itching around the anus, as well as difficulties in maintaining hygiene. Keep in mind that this is an infectious disease, one of the sexually transmitted diseases that you caninfect other people, especially your sexual partner.

Genital warts are a predisposition to the development of an anal cancer in the future, therefore it is important to periodically check changes with a specialist doctor.

  • Genital warts: causes

The cause of the appearance of genital warts is an infection with Human Papillomavirus (HPV) types 6 and 11.

  • Genital warts: treatment

There are conservative and surgical treatment of condylomas. The therapy begins with the use of pharmaceuticals, but if it does not bring satisfactory results to the patient and the doctor, invasive treatment can be introduced.

The surgical methods of removing acuminata include laser therapy, cryotherapy, photodynamic therapy, as well as curettage and electrosurgical methods, most often performed under general or local anesthesia in an operating theater.

Despite the surgical removal of the condylomas, there is a high risk of recurrence of the disease and the need to undergo another treatment.

Anal cancer

Anal cancer in society affects 1 in 100,000 people per year, it accounts for approximately 2% of all colorectal cancers. It mainly occurs in people over 60-70 years of age. age. Women fall ill more often, four times. People infected with HIV and homosexuals are more predisposed to the development of the neoplastic process.

  • Anal cancer: causes

Most people diagnosed with anal cancer have also been found to be infected with the human papillomavirus, i.e. HPV (Human Papillomavirus), mainly types 16 and 18. Fistulas and anal fissures, as well as genital warts.

  • Anal cancer: symptoms

The most common complaints reported by patients include rectal bleeding, pain, itching, burning, staining underclothes, and faecal incontinence problems. In the advanced stage of the disease, a neoplastic tumor may be palpable and even visible in the anorectal area.

  • Anal cancer: treatment

Treatment of an anal cancer largely depends on its histological structure and the stage of development in which it was diagnosed. Extensive local infiltration and the presence of metastases contribute to a much worse therapeutic effect.

  • Anal cancer: prognosis

5-year survival is observed in about 70% of patients who inat the time of diagnosis, they had no regional lymph node metastases or metastases to distant organs.

Help the development of the site, sharing the article with friends!

Category:

Gastrology