Diplomate, Board Certification of Emergency
Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
Rectal and anal disorders are some of the most painful
disorders, in addition to being embarrassing. Once stool gets
to the last part of the bowel, which is called the rectum, it
is in a solid form and is stored there until it is released.
The anus is where it is released from and it has a rich
supply of nerve endings which means that disorders here are
very painful. In addition, stool is full of bacteria, so the
leakage of stool can complicate things by causing
infections.
The most common anal disorder is hemorrhoids, which are
basically blood vessels which have become swollen. They can
be internal, which are painless, but cause intermittent
bleeding. They can also be external, which can often be
painless, but if they fill with blood clots, or if they
become infected or strangulated they can cause excruciating
pain. They are common after childbirth.
The main treatment for both these disorders is warm
baths, bulking agents (such as fiber) and softening agents in
the stool. These act to lower pressure in the rectum and thus
prevent pressure on the blood vessels. Creams are often used
in Israel, while in the USA they are less popular. There is
controversy if they really help; but I do not believe they
cause any damage. Occasionally, surgery is required for
hemorrhoids.
Fissure in Ano is another painful condition which is a
tear in the anus. These respond well to the above therapy,
but again surgery may be required. They often present with a
hemorrhoid as well. They often present with blood on the
toilet paper. In both these conditions, straining to release
stool must be avoided, and meticulous cleaning is
recommended. I believe baby wipes are the way to go, but one
must be careful to dry the area afterwards.
There are few conditions which are as painful as an anal
abscess, or one that is nearby. These, like most abscesses
must be lanced, but are so painful that without anesthesia,
it is practically impossible to do this, not to mention
inhumane. In addition, they often have tunnel into the skin
to involve other parts of the rectum so they need close
follow up by a surgeon.
Rectal prolapse is when the rectum basically falls out.
Common in children, occasionally due to pinworm infestation,
they frequently do well with just returning them inward with
a well lubricated gloved hand and adequate pain relief. In
adults, frequently the elderly, returning the rectum inward
is not sufficient and they require surgery. In any event,
this is not a condition to wait on.
Tumors do occur in the rectal area, and that is why a
rectal exam is so important in your yearly checkup. They are
curable early.
A pilonidal cyst is a little tunnel in the lower back
near the beginning of the buttocks that is due to hairs that
grow inward. They can get infected and become abscesses which
often need surgery as well.
Pruritis Ani is itching in the anal region and is very
common. Usually it is due to incomplete cleaning of the area,
but a variety of diseases can cause this. Other common causes
are pinworm, the wearing of tight fitting synthetic
underwear, diabetes, skin disorders such as allergic
reactions or psoriasis, and fissures. A complete workup
included looking inside with a scope are warranted if
pinworm, soiling and synthetic underwear are ruled
out.
Children often have bleeding and soiling from other
causes, but we are out of room. Write me in care of the
Yated.
Summer colds don't need antibiotics usually, but be
careful with the elderly. Pneumonia can be quick and lethal.
In a diagnosed pneumonia, Zinnat and its intravenous
equivalent Zinnacef can be an older person's best friend.
Strong medicine to save lives.
