Hemorrhoids are dilated veins located beneath the lining of the anal canal. Internal hemorrhoids are located in the upper anal canal. External hemorrhoids are located in the lower anal
Internal hemorrhoids become symptomatic when constipation causes disruption of the supporting tissues and resultant prolapse of the dilated anal veins. The most common symptom of internal hemorrhoids is painless rectal bleeding, which is usually bright red and ranges from a few drops to a spattering stream at the end of defecation. If internal hemorrhoids remain prolapsed, a dull aching may occur. Blood and mucus stains may appear on underwear, and itching in the perianal region is common in hemorrhoids, hemroids, hemorhoids, hemorroids, perianal abscess, proctalgia fugax, levator ani syndrome, anal fissure, pruritus ani, pruritis
Management of internal hemorrhoids
Grade 1 and uncomplicated grade 2 hemorrhoids are treated with avoidance of nonsteroidal anti-inflammatory drugs and
Symptomatic grade 2 and grade 3 hemorrhoids. Treatment consists of hemorrhoid banding with an anoscope Major
Grade 4 hemorrhoids require surgical hemorrhoidectomy.
External Hemorrhoids
External hemorrhoids occur most often in young and middle-aged adults, becoming symptomatic only when they become thrombosed.
External hemorrhoids are characterized by rapid onset of constant burning or throbbing pain, accompanying a new rectal lump. Bluish
An anal fissure is a longitudinal tear in the distal anal canal, usually in the posterior or anterior midline. Anal fissures may be associated with secondary changes such as a sentinel tag, hypertrophied anal papilla, induration of the edge of the fissure, and anal stenosis. A patient with multiple fissures, or whose fissure is not in the midline, is more likely to have Crohn's disease.
Treatment
High fiber foods, warm sitz baths, stool softeners (if necessary), and daily application of 1% hydrocortisone cream to the fissure
Lateral partial internal sphincterotomy is indicated when 4 weeks of medical therapy fails. It consists of surgical division of a
Levator ani syndrome refers to chronic or recurrent rectal pain, with episodes lasting 20 minutes or longer. Proctalgia fugax connotes
Levator ani syndrome and proctalgia fugax are more common in patients under age 45, and psychological factors are not always
Levator Ani Syndrome is caused by chronic tension of the levator muscle. Proctalgia fugax is caused by rectal muscle spasm. Proctalgia fugax and levator ani syndrome have not been found to be of psychosomatic origin, although stressful events may trigger attacks.
Diagnosis and clinical features
Levator ani syndrome is characterized by a vague, indefinite rectal discomfort or pain. The pain is felt high in the rectum and is
Treatment
Levator ani syndrome. Treatment with hot baths, nonsteroidal anti-inflammatory drugs, muscle relaxants, or levator muscle
Proctalgia Fugax. For patients with frequent attacks, physical modalities such as hot packs or direct anal pressure with a finger or
Pruritus ani is characterized by the intense desire to scratch the skin around the anal orifice. It occurs in 1% of the population. Pruritus ani may be related to fecal leakage.
Patients report an escalating pattern of itching and scratching in the perianal region. These symptoms may be worse at night. Anal
The anal glands, located in the base of the anal crypts at the level of the dentate line, are the most common source of perianal infection. Acute infection presents as an abscess, and chronic infection results in a fistula.
The most common symptoms of perianal abscess are swelling and pain. Fevers and chills may occur. Perianal abscess is common in
Management of perianal abscess. Perianal abscesses are treated with incision and drainage. If the abscess is small, incision and