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Perianal miscellaneous conditions and … (April, 2006)

Details about common conditions in and around anus, like Piles and Fissure in ano and Fistula in ano have been described in earlier newsletters. There are few more miscellaneous conditions and one very serious and important disease – Cancer in Rectum or Anal canal.

Perianal Haematoma.
This is a very painful condition, starting suddenly with a swelling around the anal verge and severe pain usually following an episode of excessive straining at stools. The examining doctor would be able to differentiate it from an abscess by the absence of features of infection like fever and bluish discoloration of skin over the perianal bulge. It is due to rupture of a blood vessel under the perianal skin due to excessive straining and resultant congestion and increased pressure within the blood vessel. It is often misdiagnosed and mistreated with lots of antibiotics and pain killers and local applications. Though swelling may resolve partially and pain gradually over a period of couple of weeks, best option is a simple and small out patient surgery. Making a small "nick" with a pointed knife under local Xylocaine injection, results in the blood clot popping out like a "pea from a pod" and gives immediate and dramatic relief. The small puncture seals off in 24 – 48 hours with no need even for a dressing!

Other perianal miscellany:
Other skin folds occurring due to no known reasons, viral warts (minute, multiple, cauliflower like protrusions), larger stalked (pedunculated) grape like "papillomas" and itchy scaly dry "eczematous" lesions are some of the nuisance conditions in this area. These may be treated by cauterization or excision or by some local applications, if needed with the assistance of a Dermatologist. Stenosis or narrowing of the anal canal may follow improperly performed piles operation, causing difficulty in evacuating the bowel and necessitating excessive straining at stools. This may even lead to secondary "Fissure".

Cancer of the Anal canal and Rectum:
Recent alteration in the bowel habits, which has been regular for several years, a sense of incomplete evacuation after every bowel movement, excessive and persistent discharge of mucus and above all some form of bleeding with stools like in piles are some of the cardinal features of Cancer in the anal canal and rectum or higher up in the large bowel, called "Colon". It is in fact recommended that anyone having bleeding with motion, especially older age group should have a sigmoidoscopic examination to make sure there is no cancer higher up. If any suspicious area/lesion is seen, it should be biopsied for confirmation. Except cancers low down in anal canal, most other cancers in these areas are painless. Because of absence of pain, a patient often tends to delay seeking medical attention.

Cancers in anal canal or rectum or colon, if diagnosed in its early stages, can be cured completely by a combination of Surgery, radiation and chemotherapy. But with delay and consequent spread of the disease, chances of cure would be reduced.

The information regarding many of these diseases like Piles, Fissure and even cancer is to make you suspect something serious whenever there are any symptoms even in the absence of pain . Do not feel shy to consult your doctor or a surgeon in the earliest stages of the disease so that it can be completely cured even if it turns out to be serious disease.

Be well informed; be proactive; take out any doubt in your mind by consulting a qualified Doctor or Surgeon.

Page updated and info added on March,2013:

i) Management of Fistula in Ano with Fibrin Glue – go to:
http://www.techgiendoscopy.com/article/S1096-2883(04)00011-7/abstract

ii) VAAFT Surgery for Fistula in ano: Go to
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226694/

Ref: Tech Coloproctol. 2011 December; 15(4): 417–422.

Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,

Director & Senior Surgeon (Retired but not tired),
Dr. U Mohan Rau Memorial Hospital.
Email: mmr@mohanraohospital.com




 

Updated on March 2013.
 

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