Anorectal disorders

Background

Anatomy of the anus.

Visual Diagnosis

• 

  Anal tags

• 

  External hemorrhoid

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  Anal fissure

• 

  Anal warts

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  Perianal abscess

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  Internal hemorrhoid with prolapse

• 

  Pilonidal cyst

Differential Diagnosis

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

Evaluation

Algorithmic Diagnostic Approach

• Pain
  • Bleeding
    • External hemorrhoid
    • Prolapsed internal hemorrhoid
    • Anal Fissure
      • Off midline = cancer, HIV, TB, Crohn's
  • No bleeding
    • Swelling
      • Anorectal abscess
        • Perirectal
        • Ischiorectal
        • Intersphincteric
        • Supralevator
      • Pilonidal cyst
      • Anal fistula
      • Hidradenitis suppurativa
    • No swelling
      • Proctalgia fugax
• No pain
  • Bleeding
    • Cancer
    • Internal hemorrhoid
  • Swelling
    • Itch: Condyloma acuminata
    • No itch: Rectal prolapse
  • Itching
    • Discharge: Proctitis
    • No discharge: Pruritus Ani

See Also

• Diagnoses by Body Part (Main)