May 2010|Vol 7|Issue 5

May 2010 | Volume 7 | Issue 5


Differential Diagnosis of Ano Rectal Diseases


Dr.Anand Pd .Mirgary.
G.D. College Road,
Begusharai, Bihar.
Mobile: 09431861305

    Differential Diagnosis of Ano Rectal Diseases is clinically essential for every physician to offer prompt and fast recovery. Hemorrhoids, Fissures, Rectal abscess and Fistula in ano are very common disorders. To achieve comprehensive cure the typical symptoms of observation for patients suffering from ano rectal disease includes: bleeding, pain, discharge and itch. The following glimpses could help a physician to probe the ano rectal conditions

    Symptomatology of anorectal pathologies:
    1. Anal pain
    2. Bleeding per rectum
    3. Pus discharge from and around anus
    4. Anal pruritus
    5. Presence of swelling or lumps in or around anus
    6. Difficulty in passing stool
    Common anorectal Conditions
    1. Anal fissures
    2. Sentinel pile
    3. Fistula in ano and Ano Rectal Abscess
    4. Pilonidal Abscess
    5. Haemorrhoids
    6. Rectal Polyps

    Anal fissures
    Acute anal fissures are superficial and are usually multiple.Chronic anal fissures are mostly found on the posterior or anterior midline. They are often associated with pathologies like sentinel tags, anal papillae, fibrous polyps or hemorrhoids, poisoning and infection. Intense pain during defecation, H/o hard stool, with streaks of blood gives clues to the physician to confirm by local examination

    Sentinel pile
    Sentinel pile a hemorrhoid-like thickening of the mucous membrane at the lower end of an anal fissure.The swelling at the lower end of a chronic anal fissure, palpable as an anal mass, which may be the first or most prominent manifestation of a fissure, hence, a ‘sentinel’ This condition very often found clinically.

    Fistula in ano and Ano Rectal Abscess
    The anorectal area may be involved in several infectious and inflammatory processes. Abscesses often have their origin in an infection in the anal glands. The suppurative process then tracks through the various planes in the anorectal region. The infection can present at the anal verge as a perianal abscess.

    Fissure in Ano
    Fistula in Ano

    Pilonidal Abscess
    A pilonidal cyst develops along the coccyx near the cleft of the buttocks. These cysts usually contain hair and skin debris. The term pilonidal is derived from the Latin words pilus (hair) and nidus (nest). Individuals with a pilonidal cyst may not have any symptoms at all, whereas others may develop an infection of the cyst with associated pain and inflammation. The treatment and management of pilonidal cysts depends on many factors, including the presence of symptoms and the extent of the disease. Recurrence of pilonidal cysts is common.

    Haemorrhoids are varicose veins. External haemorrhoids originate below the anorectal line and are covered by anal skin. When uncomplicated, they may not be visible at rest, but a thrombosed haemorrhoid presents as a painful, bluish, shiny, ovoid mass at the anal margin. Flabby or fibrotic skin tags may mark the location of previously thrombosed or inflamed haemorrhoids.

    Internal hemorrhoids originate above the anorectal jucnction and are covered by mucous membrane, not skin. They are not visible unless they prolapse through the anus, nor are the soft swellings normally identifiable by palpation. Proctoscopic examination is usually required for diagnosis.

    Pilonidal Abscess

    Rectal Polyps
    A polyp is a growth of tissue from the intestinal or rectal wall that protrudes into the intestine or rectum and may be benign or malignant. Polyps vary considerably in size, and the bigger the polyp, the greater the risk that it is cancerous or precancerous. Polyps may grow with or without a stalk. Those without a stalk are more likely to be cancerous than those with a stalk. Adenomatous polyps, which consist primarily of glandular cells that line the inside of the large intestine, are likely to become cancerous Serrated adenomas are a particularly aggressive form of adenoma.

    Most polyps do not cause symptoms. When they do, the most common symptom is bleeding from the rectum. A large polyp may cause cramps, abdominal pain, or obstruction. Large polyps with tiny, fingerlike projections (villous adenomas) may excrete water and salts, causing profuse watery diarrhea that may result in low levels of potassium in the blood (hypokalemia). Rarely, a rectal polyp on a long stalk drops down and dangles through the anus.