ANAL AND PELVIC

Pain from the anal region can cause a lot Medical treatment includes avoidance of Treatment includes warm bath, sphincter of concern, as it is an unusual experience. by fiber supplement, , breaking medications (Diltiazem, The nature of the pain can often be a and stool softeners; and application Valium), and Botox injection. of topical hemorrhoidal and steroid clue as to the underlying cause. See a SYNDROME is a ointments. Surgical treatments include condition which more often affects women COLORECTAL SURGEON to properly office based rubber banding and injection than men, and is thought to result from investigate and manage this condition. sclerotherapy, and operative room ligation and excision. spasm of the upper most layer of the anal sphincter (puborectalis muscle). It typically TYPES AND COMMON CAUSES Sometimes development of a blood clot causes a dull aching pain or discomfort of OF PAIN in the external can give sharp the anus that lasts more than 20 minutes • A knife-like pain when you pass a A fissure is usually caused by a hard throbbing pain which develops acutely. and frequently hours to days. It is often bowel motion which may last for stool. This stretches and tears the opening. In such cases the best treatment is to get exacerbated by sitting for long periods or Anal fissures result in severe pain on 10–15 minutes afterwards is probably the thrombosed hemorrhoids excised lying down, and relieved by walking. defecation, with anal sphincter spasm, which can be done in the office under local caused by an anal fissure. Some people and further tearing. This often leads to anesthesia. describe it as like ‘passing glasses.’ In the avoidance of defecation, establishing a Examination of the anus is usually addition to the pain, you may notice vicious cycle of constipation and repeated ANAL PRURITIS (also known as unremarkable with only palpable anal fissuring. tenderness of the levator ani muscles, some bright red blood on the toilet “pruritis ani”) is persistent itching of the skin around the anus. This condition can signifying puborectalis spasm. Anal paper. Medical treatment includes avoidance of cause intolerable discomfort. Regardless of manometry typically shows increased anal • A similar knife-like pain can be caused constipation by fiber supplement, laxatives, cause, the problem is exacerbated by a self- pressures. by the virus. and stool softeners; and application escalating “itch-scratch-itch” cycle. • A nagging, aching discomfort made of ointment to relax the sphincter muscles. If not healed by medical The aim of treatment is to reduce anal worse by defecation could be due to Causes include over cleaning, which canal or levator ani tension. Hot sitz treatment then surgical treatment options can remove natural oils that protect the hemorrhoids. include: Botox injection to relax sphincter skin, increased moisture, food and drinks baths have been shown to be of some use, • Burning pain and itching in the skin muscles, cutting the sphincter muscles (mainly coffee), anorectal conditions on their own, as well as in combination around the anus might be a skin partially, and advancement flap. such as hemorrhoids, rectal , with massage and muscle relaxants condition known as pruritis ani. , , incontinence, (). Digital massage of the muscle, HERPES SIMPLEX VIRUS electrogalvanic stimulation by a rectal • A throbbing pain, worsening over 1-2 warts, yeast infection, pre cancerous and INFECTION of the anal region can cancerous conditions of the . probe, and biofeedback regimes utilizing days and bad enough to disturb your produce a pain similar to an anal fissure. pressure-measuring probes can be tried. sleep, is likely to be caused by an anal Herpes can infect the anal area, either Treatment includes avoiding soap, spread by the hands from a cold sore abscess. dietary restrictions, keeping area dry, avoid COCCCYGODYNIA refers to pain on the face or transmitted as a sexual scratching, anti fungal and steroid creams. • Sudden severe of anal pain felt infection. The soreness occurs in episodes, over the ‘tail-bone” (coccyx). It is more deep in the anal canal lasting seconds each lasting for a few days. Treatment may ANAL ABSCESS results when an anal common in women, and can result from to minutes, with no pain between include topical application of 5% acyclovir gland becomes infected. It causes severe the trauma occurs after a fall or childbirth. episodes is probably a condition called (cold sore) ointment. pain in the region around the anus. There It may result from an abnormally large may also be discharge of pus or blood coccyx, or may result from a mobile . HEMORRHOIDS are a normal part • A dull aching pain or discomfort of the from the anus with an offensive odor. This coccyx. Occasionally it results in chronic of the anatomy that we are born with. collection can happen in the anatomical arthritis, or bursitis, or the development anus, that lasts more than 20 minutes, We have two sets; internal and external. spaces around the anal canal. Symptomatic hemorrhoids are swollen of a bony spicule that can lead to more and frequently hours to days, may be . due to levator ani syndrome. (enlarged, dilated) veins inside and outside Anal abscess is treated by making an the anus. Hemorrhoids are usually caused • Pain over the ‘tail-bone (coccyx) may opening in the skin near the anus to drain by increased pressure, such as straining the pus from the infected cavity and Treatment includes be due to coccygodynia. when constipated. Hemorrhoids may cause thereby relieve the pressure. Often this can medication that may help reduce pain • A continuous aching pain in the anus pain, bleeding, blood clots, and itching. be done in the office using local anesthetic. and inflammation. Hot sitz baths and in which all of the above causes have donut cushions for sitting, to reduce direct been excluded, suggests referred pain PROCTALGIA FUGAX is characterized pressure on the coccyx, can often alleviate caused by a back problem (when a part by severe, episodic, anal pain. It commonly pain. If medical treatment does not work occurs at night time, causing waking from of the spine presses on a nerve). then steroid injection and amputation of sleep. It is typically severe and lasts for a coccyx can be performed. few seconds to minutes. It can be caused by a spasm or cramping of the anal sphincter ANAL FISSURE, simply put, is a cut. Anal and can be annoying It is in an area that requires constant use. muscles. It is a diagnosis of exclusion, and provided other conditions that cause anal and affect your daily life and in worst Because the anal canal is richly innervated pain are excluded, then the approach is cases can even cripple you. See a with sensory pain fibers, a fissure is often generally simple reassurance and symptom COLORECTAL SURGEON to discuss very painful. control. the management options.