Anal Conditions

Itching
This is known as pruritus ani, or an “itchy bottom”. This is common particularly in men. Piles (haemorrhoids), threadworm and fungal infections need to be excluded but in most cases no cause is found.

Treatment consists of good personal hygiene, the avoidance of strongly perfumed soaps and deodorants and keeping the area dry. Regular changes of underwear are recommended.  Where candida or thrush infection occur then antifungal creams are some times helpful.

Haemorrhoids or piles
These can cause pruritus ani and rectal bleeding. The blood is usually noted when wiping the bottom with toilet paper. Haemorrhoids are enlarged blood vessels similar to varicose veins but occurring around the inside of the anus. They can be internal and seen only with a proctoscope (instrument inserted into the rectum) or can enlarge to become external and easily seen. Occasionally the piles can come out (prolapse) stay out and become thrombosed and very painful.

Treatment includes reducing constipation by bulking agents or if the piles are troublesome they can be injected with a sclerosing solution which causes them to clot, or by rubber band ligation. In very severe cases they can be excised by a surgeon under a general anaesthetic.

Anal Fissures
Anal fissures are small tears in the skin of the lower anal canal. This area is very sensitive and the condition is rather painful particularly if the patient strains on passing a stool. It can be associated with bleeding, discharge of mucus and itching. There is often a small skin tag just
outside the anus, called sentinel pile. This condition may be helped by anal stretching or dilatation under general anaesthetic, although in minor cases application of a local anaesthetic gel can be helpful.

Faecal Incontinence
This is the passage of faeces when the patient does not wish this to happen. i.e. there is a loss of control of the passage of faeces. This can occur in anyone who experiences acute diarrhoea where the stool is very, very liquid. Partial incontinence is a minor soiling and commonly occurs in the elderly. Major incontinence is when there is significant loss of control even when the stool is formed. In order for continence to be maintained there has to be the experience of rectal sensation and the ability to control the anal sphincter. The stool must be firm enough to
hold on to, there needs to be a suitable place in which to go to the toilet and the patient needs to be able to get to the toilet.

Causes of incontinence include poor mobility so that the toilet is never reached, dementia where there is no social awareness of the need to pass a stool in the right place, and neurological lesions where either the sensation of stool in the rectum or the ability to control the anal
sphincter are lost.

Causes of faecal incontinence include damage to the nerve supply to the pelvic floor muscles during childbirth, neurological disorders such as multiple sclerosis, spina bifida and paraplegia due to spinal trauma, psychiatric disorders such as dementia or Alzheimer’s disease; anorectal disease such as rectal prolapse, rectal tumours and inflammatory bowel disease; severe constipation with overflow of liquid stool; inherited abnormalities of the ano-rectal region; severe diarrhoea.

Treatment depends on the cause of the incontinence. Where damage has been due to childbirth then repair of the anal musculature may be helpful. Where incontinence is due to diarrhoea then drugs such as Loperamide or Lomotil which reduce the stool volume may be useful; where constipation and overflow diarrhoea occur then measures to treat the constipation such as laxatives are helpful. Where dementia is the cause, then re