Gastroenterology
Anorectal Disorders
Gastroenterology

Anorectal Disorders

Fissure, hemorrhoids, abscess, fecal impaction.

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◆Anal fissure

  • •Severe pain with defecation + BRBPR on TP
  • •Posterior midline most common
  • •Atypical location: consider Crohn, HIV, malignancy
  • •Conservative: fiber, hydration, sitz baths, topical CCB (nifedipine) or nitroglycerin
  • •Botulinum or sphincterotomy if chronic

◆Internal hemorrhoids

  • •Painless BRBPR during/after BM (above pectinate line, visceral innervation)
  • •Conservative: high-fiber + fluids + sitz baths + topical care
  • •Persistent → rubber band ligation
  • •Refractory/grade IV → surgical excision
  • •Always exclude cancer in older patients with red flags → colonoscopy

◆External hemorrhoids

  • •Pain only if thrombosed
  • •Perianal abscess: tender fluctuant + fever → I&D

◆Fecal impaction (with overflow diarrhea)

  • •Elderly on opioids + 5 days no BM + leakage of loose stool + hard stool on rectal exam
  • •Enema or manual disimpaction
  • •Then bowel regimen + reduce opioids
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