Other conditions encountered around the anus and associated with haemorrhoids

Miscellaneous Conditions

Other conditions encountered around the anus

Pruritus ani is an itchy rash around the anus. Often this is associated with an anal fissure, which discharges some fluid in the area. Sometimes it is due to an allergy or a fungal infection.

Usually treating the fissure relieves the pruritus completely but sometimes special diet modifications or creams with an anti-fungal like Canesten are used.

Abscesses occur around the anus. These can be ordinary boils, but often they are an infected anal gland from the 20 or so in the area of the anus. These can be very dangerous because they can develop into a large abscess in a space on each side of the anus called the ischio-rectal fossa. The pus requires immediate drainage usually under a local anaesthetic. 50% of these abscesses heal without problems, but in the other 50% a worm like track to the inside of the anus persists. This tract crosses the sphincter and needs carefully removed so that there is no continence problem. Avoiding surgery leads to recurrent abscesses.

Skin tags are the expanded skin on the outside of the anus when haemorroids have been ignored for a long time.enlarge image
Skin tags are the expanded skin on the outside of the anus when haemorroids have been ignored for a long time. Although they are not dangerous, it is difficult to keep clean with these and they can be removed under local anaesthetic.

Because there are a lot of nerves in the area, it is painful for several days after removal and a local anaesthetic cream is used to help.

A sentinel tag is again a skin lump at the outside of the anus. This is at the outside of a fissure and “guards” the fissure. The fissure is treated first and the tag shrinks and often disappears. If it is removed without treating the fissure it comes back. Sometimes it is big enough that it should be removed under local anaesthetic after the fissure has healed.

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Other bowel conditions associated with haemorrhoids

The most important is cancer which we found in 0.2% of patients with haemorrhoids using a combination of sigmoidoscopy, stool testing and where indicated colonoscopy.

Constipation can be a chronic and difficult problem. The best way to treat this is to stop taking laxatives long term (Senna and Cascara use will lead to a lazy bowel). Instead take two tablespoons daily of Bran or Flax or Psyllium or Benefibre plus 7 to 8 large glasses of water. If this fails, yoghurt may help or taking one or two capsules of Lactobacillus Bulgaris daily.

Inflammatory bowel disease is also associated with haemorrhoids and fissures and fistulas and is picked up from the history and sigmoidoscopy in most patients.

The commonest cause of bowel symptoms is Irritable Bowel Syndrome which is characterized by periodic cramps and abdominal pains relieved by bowel movements. This can often be determined by history alone and taking bran (or flax or psyllium or Benefibre) and water helps but does not completely relieve the condition.

Diverticulosis is pockets in the colon resulting from lack of fibre in the diet and is characterized by stools that resemble rabbit pellets and constipation. An X-ray will show this and extra bran (flax, psyllium or Benefibre) and water is the treatment of choice to prevent complications such as the dangerous inflammation that can occur (diverticulitis).

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Rare conditions

Warts can be treated by creams or cautery, usually in specialized clinics. These are highly infective.

Genital herpes usually is a recurring problem and is highly infective when there is an open sore.

Syphilis and gonorrhoea occur in the lower rectum and require antibiotics and are highly infective.

Cytomegallic Virus (CMV) and squamous cancer of the anus occur, more frequently in patients with AIDS.

There are raised areas sometimes from pre-cancerous lesions around the anus and rarely melanoma.

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