Anal Pathology - Types, Symptoms, and Treatment

Introduction:

The anal canal is four centimeters long. It is made up of columnar rectal mucosa and squamous anoderm. Infections occur in the anal and perianal regions. The interior surface of the anus area is made up of crypts. Diseases of the anus can affect any population but are more commonly seen in the young population and children. Types of anal diseases are as follows:

1. Hemorrhoids.

2. Anal fissure.

3. Anal fistula.

4. Anal abscess.

5. Pruritus (itching).

6. Anal cancer.

7. Congenital lesions.

8. Rectal prolapse (the rectum loses its attachment with the body tissue).

What Are Hemorrhoids?

Hemorrhoids are also known as piles. These are caused due to hypertrophy or inflammation of the cellular cushion. As a result, the supporting structures like blood vessels, connective tissue, and muscles weaken and cause bleeding.

Causes:

• Diet: A low-fiber diet leads to constipation.

• Infection: Any secondary infection caused due to trauma.

• Venous Obstruction: Reduced blood flow due to tumor, pregnancy, ascites, or hypertension.

• Multiple Sclerosis: Seen in neurological conditions.

• Others: Aging or displacement of tissue.

Clinical Features:

• Bleeding.

• Pruritus (itching).

• Anal pain.

• Hygiene difficulty and itching.

• Complications:

• Ulceration.

• Gangrene formation (death of tissue due to reduced blood flow).

• Fibrosis.

• Thrombosis.

Types:

• Internal: Affecting above the dentate line. Depending upon the severity, it is again divided into grades I, II, III, and IV.

• External: Affecting below the dentate line.

Treatment:

• Medical Therapy: Stool softeners and systemic analgesics are administered.

• Minimally Invasive Therapy: Procedures like rubber dam ligation, laser, and infrared coagulation are done.

• Surgical Therapy: Procedures like laser hemorrhoidectomy, cryosurgery, and stapled hemorrhoidopexy are performed.

Diagnosis:

• Anoscopy.

• Physical examination.

• Digital rectal examination.

What Are Anal Fissures?

The tear from the opening of the rectum is called an anal fissure. Due to this pain, severe pain along with discharge is noted. In acute conditions, it takes four weeks for healing to happen. If the healing takes longer, it is considered a chronic fissure lasting more than six weeks.

Causes:

• Hard stools.

• Trauma.

• Sexually transmitted disease.

• Increased muscular tone.

Types:

• Acute: Inflammation is seen in the midline region, followed by pain. Severe sphincter or muscular spasm is noted.

• Chronic: It is less painful but shows inflammation. A hypertrophied papilla can be seen projecting internally or externally.

Risk Factors:

• Low fiber diet.

• Anal surgery.

• Diarrhea.

• Inflammatory bowel disease.

Complications:

• Fecal bacterial infection.

Diagnosis:

• Local examination.

Treatment:

• Conservative Treatment: Giving stool softeners, ointments, and sitz baths.

• Surgical Procedure: Lateral anal sphincterotomy is done.

What Is a Fistula?

A fistula is the connection between the rectum canal and the perianal region, forming a division or a split in between.

Causes:

• Trauma.

• Crohn’s disease.

• Malignancy.

• Radiation.

• Infections like tuberculosis, chlamydia, and actinomycosis can cause a fistula.

Types:

Depending on the location:

• Pelvi-rectal fistula.

• Submucosal fistula.

• Subcutaneous fistula.

• High-anal fistula.

• Low-anal fistula.

Depending on the muscular supply:

• Supralevator fistula.

• Intersphincteric fistula.

• Transsphincteric fistula.

Symptoms:

• Bleeding stools.

• Skin excoriations.

• Pus draining.

• Redness.

• Itching.

• Pain.

• Swelling.

Treatment:

• Drain the infection and discard the lesion. Preserve the anal sphincter function.

• Surgical procedures like fistulectomy with curettage are done. In addition, another method, like fistuloectomy followed by flap grafting, is also practiced.

What Is Hypertrophied Anal Papillae?

Hypertrophied anal papillae are skin tags that project from the junction present between the anus skin and the epithelial lining. These are similar to polyps but occur in white and are usually firmer than polyps. Hypertrophied anal papillae can be treated through surgical excision, cryotherapy, or electrodesiccation.

What Are Anal Abscesses?

An infection was found near the rectal opening and was filled with pus. The main causative agent is E. coli bacteria. It is mostly seen in the cryptoglandular region. Other conditions causing such abscesses are diabetes, Crohn's disease, immunosuppression, and fistula formation. Symptoms arise like pain, throbbing swelling, and fever. Management of anal abscesses is done by draining out the pus with antibiotic therapy. There are mainly four types of anal abscesses. They are ischioanal or ischiorectal abscesses, intersphincteric or intramuscular or submucosal abscesses, perianal abscesses, and supra levator abscesses.

What Causes Pruritus in the Buttocks Area?

The pruritus causes irresistible itching in the buttocks area. The skin becomes reddened, moist, hyperkeratotic, and cracked. The main cause of pruritus is poor hygiene, anal discharge, tuberculosis infection, parasites, and epidermophytosis. Other conditions like allergies, skin diseases, dermatitis, psoriasis, and persisting health conditions like diabetes can induce pruritus.

• Treatment: Proper hygiene should be maintained. Administration of Hydrocortisone for patients suffering from dermatitis is done. Also, strapping of the buttocks region is done.

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a chronic condition forming pus from apocrine glands in the buttocks region. It is caused by infection, pustules, or fistulas. It is a superficial lesion not extending beyond the muscular region. Hidradenitis suppurativa is seen more in women than in men. People who are obese are at risk factor of developing this condition.

• Symptoms: It is seen as a red scarred area, pus-filled discharge occurs, foul odor is dispelled, and pain and tenderness are observed.

• Differential Diagnosis: Crohn’s disease, pilonidal sinus, tuberculosis, actinomycosis.

• Treatment: Maintaining hygiene of the area by frequent washes with liquid soap and applying Soframycin or Betadine topical creams. Washing the area with soap and water and shedding body weight. Surgical management is done by incision, drainage of apocrine glands, and reconstructive flap surgery.

What Are Anal Warts?

Anal warts are caused due to sexually transmitted diseases. It is most commonly seen in herpes simplex virus infection and homosexual people. Mostly, it is exhibited as an asymptomatic condition.

• Symptoms: It appears as a painful purulent lesion, and bleeding is seen.

• Treatment: Application of 25 percent Podophyllin cream topically, and surgical excision is done under local anesthesia.

What Are the Acute Cancer Conditions of Anus?

Anal intraepithelial neoplasia is a skin condition seen in the anus. It is an acute disease. It is caused by the human immunodeficiency virus (HIV) and Herpes simplex virus (HPV). It is seen in patients having anal sex. About 30 percent of anal warts tend to develop into anal intraepithelial neoplasia. Intraepithelial neoplasia is classified into grades I, II, and III depending upon the spread. It is seen as a white, scaly, raised, and cracked lesion. The diagnosis can be confirmed by biopsy.

• Treatment: Local excision can be done, and topical application of Imiquimod and oral medicament of Retinoids can be taken.

What Are the Malignant Tumors Associated With Anus?

Malignant tumors or cancers of the anus constitute about two percent of bowel tumors. These are mainly caused by Herpes simplex virus (HPV), immunosuppression, organ transplant, and human immunodeficiency virus (HIV). It is manifested as an ulcerative lesion involving the inguinal lymph nodes.

• Treatment: Early tumors detected are managed by local excision as they appear superficially or spread inside the dentate region. Other treatments like combined modality therapy (CMT) are primarily done by CT (5 FU + Mitomycin C or Cisplatin) for three weeks.

Conclusion

Anal diseases are visual abnormalities. They are often painful, with discharges affecting the defecation process. Therefore, maintaining a fiber-rich diet can bring a lot of differences along with medical and surgical management.