SU28.17 | Common Anorectal Diseases — Summary & Reflection

KEY TAKEAWAYS

Common anorectal diseases are best sorted by their dominant symptom and anchored in the dentate line. Haemorrhoids are enlarged anal cushions: internal (above the line, painless bleeding, graded I–IV) versus external (below, painful when thrombosed); managed by fibre/softeners → banding/sclerotherapy → haemorrhoidectomy. Anal fissure is a posterior-midline anoderm tear (chronic triad: sentinel tag, ulcer, hypertrophied papilla; lateral/atypical → suspect Crohn's/TB/malignancy/HIV), managed by softeners → topical GTN/diltiazem → botulinum toxin → lateral internal sphincterotomy. Perianal/anorectal abscess (cryptoglandular) needs incision and drainage, not antibiotics alone, and may leave a fistula-in-ano, mapped by Goodsall's rule and treated by fistulotomy (low) or a seton (high, to preserve continence). Rectal prolapse is repaired abdominally (rectopexy) or perineally. Anal cancer is a squamous cell carcinoma (HPV-related) treated by chemoradiotherapy (Nigro regimen) with APR for salvage — distinct from rectal adenocarcinoma. Always examine (inspection, DRE, proctoscopy) and exclude a proximal colorectal cancer before blaming bleeding on benign disease.

REFLECT

Think back to a patient you have seen, or imagine clerking one, who complained of rectal bleeding, anal pain, a lump or a discharge. Did you actually examine them — inspection, digital rectal examination and proctoscopy — rather than reassure them unexamined, and did you consider whether a colonoscopy was needed to exclude a colorectal cancer? Now picture a hot, tender perianal swelling: would you have arranged prompt incision and drainage rather than reaching first for antibiotics? And faced with a chronic fissure or a high fistula, could you explain the management ladder and why a seton protects continence? Reflect on how sorting anorectal complaints by symptom, anchoring them in the dentate-line anatomy, and never forgetting to exclude a proximal cancer would make your assessment of these common, easily mishandled problems both safe and confident.