Anorectal disorders

DDX

Anorectal Disorders

• Anal fissure
• Anal fistula
• Anal malignancy
• Anal tags
• Anorectal abscess
• Coccydynia
• Colorectal malignancy
• Condyloma acuminata
• Constipation
• Crohn's disease
• Cryptitis
• GC/Chlamydia
• Fecal impaction
• Hemorrhoids
  • Internal hemorrhoid
  • External hemorrhoid
• Levator ani syndrome
• Pedunculated polyp
• Pilonidal cyst
• Proctalgia fugax
• Proctitis
• Pruritus ani
  • Enterobius (pinworms)
• Rectal foreign body
• Rectal prolapse
• Syphilitic fissure

Non-GI Look-a-Likes

• Prostatitis

Algorithmic Diagnostic Approach

Pain and Bleeding

1. External hemorrhoid
2. Prolapsed internal hemorrhoid
3. Anal Fissure
   1. Off midline = cancer, HIV, TB, Crohn's

Pain, No Bleeding

1. Swelling
   1. Abscess
      1. Perirectal
      2. Ischiorectal
      3. Intersphincteric
      4. Supralevator
   2. Pilonidal Cyst
   3. Anal Fistula
   4. Hidradenitis suppurativa
2. No swelling
   1. Proctalgia Fugax

Bleeding, No Pain

1. Cancer
2. Internal hemorrhoid

Painless Swelling

1. Itch: Condyloma acuminata (warts 2/2 HPV)
2. No itch: Rectal prolapse

Itching

1. Discharge: Proctitis
2. No discharge: Pruritus Ani

See Also

• Diagnoses by Body Part (Main)