Expert Diagnosis & Treatment

Anorectal conditions affect the anus and rectum. Fissures, fistulas, condyloma and hemorrhoids are among the most common anorectal conditions. In some cases, symptoms like pain, itching, burning, bleeding and/or swelling can significantly affect a patient's lifestyle. While most conditions are benign, a careful evaluation by a specialist is important to exclude anal cancer or another serious disorder. Colon and rectal surgeons at the University of Chicago Medicine have expertise in the diagnosis and management of these disorders.

Diagnosing Anorectal Conditions

Colorectal surgeons may use the following tools to confirm or rule out the presence of an anorectal disorder.

  • Anoscopy: A diagnostic procedure in which a small, tubular instrument with a light attached is used to view the last few inches of the rectum and anal canal.
  • Biopsy: Removal of a small piece of tissue for examination.
  • Colonoscopy: This procedure allows physicians to view the entirety of the large intestine. A colonoscopy is similar to a flexible sigmoidoscopy, but usually requires a more thorough bowel prep and is performed under moderate sedation.
  • Digital rectal exam
  • Flexible sigmoidoscopy (flex sig): A diagnostic procedure in which a small, tubular instrument with a video camera is used to view the last few feet of the large intestine.
  • Physical exam and history
  • Ultrasound or MRI: Noninvasive imaging tests that show the structure and function of the anal canal, sphincter muscles and rectum.

Types of Anorectal Conditions

An anal fissure is a small tear in the lining of the anal canal. Fissures result from constipation and/or straining during bowel movements or from chronic diarrhea. Patients usually complain of severe sharp pain during bowel movements, often with passage of bright red blood. Fissures can be quite painful and may become chronic if left untreated. These tears are common and affect men and women of all ages.

Most anal fissures can be treated without surgery. If you are diagnosed with an anal fissure, our team will work closely to develop a personalized treatment plan for you. Warm baths may soothe the area and help improve blood flow. Medications, including fiber therapy, will modify the stool and help the fissure heal. If these changes do not result in complete healing, your physician may prescribe sphincter relaxants. Surgical therapy is reserved for anal fissures that do not heal with other approaches.

On rare occasions, an anal fissure may be a symptom or sign of a disorder such as inflammatory bowel disease (IBD), sexually transmitted disease (STD) or cancer. If the diagnosis is not clear, further tests — including an exam under anesthesia or colonoscopy — may be needed to exclude other disorders.

Perianal abscess and fistula-in-ano are two related disorders that affect the anal region. Almost all abscesses develop when one of the glands lining the anal canal becomes blocked and leads to an infection. If left untreated, the abscess can develop into a fistula. A fistula is an abnormal connection between the anal canal — through some or all of the sphincter muscle — and the skin. A small number of abscesses and fistula-in-ano occur are due to other disorders, such as inflammatory bowel disease. In addition, women may develop fistula after difficult childbirth.

Symptoms of fistula can include pain, fever, redness, or drainage of purulence (pus), bloody discharge or stool from around the anus. Some patients note a full, tender swelling or bump as the first sign. Patients may also notice difficulty controlling passage of gas or stool or soiling of their undergarments.

Treating a fistula or abscess requires proper knowledge of anal and rectal anatomy. The first step is for a colorectal surgeon to perform a careful exam and control infection by draining any abscesses. This can be performed as an outpatient procedure with a local anesthetic, although more complex cases require exam under anesthesia in the operating room. If abscess drainage is successful, antibiotics usually are not required. A colonoscopy may be necessary if the diagnosis is unclear or if an underlying disorder is suspected.

Fistulas often require surgery. In order to achieve complete healing, they may require staged or sequential treatment. After a careful examination, our experts will discuss treatment options with you and recommend the best option based on the location of the fistula and amount of involved muscle.

Anal condyloma, or warts, are anal growths that develop as a result of the human papilloma virus (HPV). However, only a very small percentage of people exposed to HPV will ever develop warts (genital or anal). Although these growths may be asymptomatic, some patients may experience itching, pain, bleeding or difficulty maintaining hygiene.

Human papilloma virus (HPV) is an oncogenic virus. This means that, over time, the virus can cause a series of changes in the skin that can eventually lead to anal cancer. After anal condyloma has been diagnosed, it is important to destroy or remove all visible lesions. Depending on the location, size and number of warts, your surgeon may use a combination of office-based therapies or recommend an exam under anesthesia. Your surgeon may also recommend creams, either in addition to surgery or alone.

Surgical removal or topical therapy does not eradicate the infection and condyloma can reoccur. Sometimes, biopsies of the area show more advanced pre-cancerous changes, called dysplasia. If dysplasia is present, your surgeon will work with you to create a surveillance schedule to check for regrowth or skin changes.

Hemorrhoids are specialized vascular cushions that are a normal part of every person’s anatomy. They play an important role in continence, which is the ability to control bowel movements. Many people experience unpleasant symptoms that can be attributed to hemorrhoids. While many patients and doctors refer to this as "hemorrhoids," it is medically defined as hemorrhoidal disease. Patients who develop hemorrhoidal disease often have a history of constipation, straining, diarrhea or spending a long time in the bathroom trying to defecate. After diagnosis, the goal of treatment is to address the symptoms, not to remove all of the hemorrhoidal tissue.

Hemorrhoids are classified into two related groups. Internal hemorrhoidal disease can cause bleeding, a sensation of fullness or incomplete evacuation, leakage of stool or mucus, and prolapse or protrusion of tissue that can be painful. Patients with external hemorrhoidal disease may note a painful bulge near the anus; and/or bleeding, itching or difficulty with hygiene.

If more aggressive treatment is required, your surgeon may be able to offer one of several office-based treatments, such as rubber band ligation. Our team will discuss the best approach to treat your condition.

Pilonidal disease affects the top of the gluteal cleft near the tailbone. In this condition, broken hair is drawn into small breaks in the skin, which leads to inflammation and infection. The hair can burrow quite deep into the skin, creating long sinuses. Symptoms may include pain, redness, or drainage or abscess in the area. Pilonidal disease is most common in young men but can affect men and women in all age groups.

Patients presenting with an abscess require office-based drainage. If you are diagnosed with pilonidal disease, your surgeon will usually recommend several non-surgical methods to control symptoms, such as warm baths and keeping the area hair-free and clean. Surgery should be considered as a last resort, as wounds in this area can be difficult to heal and there is a risk of recurrence.

It is important that you and the colorectal surgeon work together to determine whether surgery is the best option for you. If the pilonidal disease is extensive and surgery is required, a multidisciplinary approach with specialists in plastic surgery may be necessary to achieve the best outcome possible.

Pruritis ani means "itchy anus." Patients may experience severe itching or an unclean feeling. Over time, pain and stinging in the anal area may develop. This condition can significantly affect quality of life and often is very frustrating to treat. Pruritis ani may be a patient's diagnosis or a symptom of an underlying disorder, such as fungal or bacterial infection, chronic skin condition, another anorectal condition or cancer.

Your surgeon will examine the area for changes in the skin, including redness. He or she will perform an anoscopy to evaluate the anal canal and rectum for associated disorders.

Depending on the cause of pruritis ani, treatment may be as simple as changing household detergent or avoiding certain foods. Pruritis ani is not normally treated with surgery, but biopsy may be required if symptoms and signs do not resolve with medical therapy. Successful treatment of this condition requires a dedicated colorectal surgeon who will work with you until healing is achieved.

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Anorectal Conditions