Daniel W John
Monash University and Bendigo Regional Clinical School, Victoria, Australia.
Aust Fam Physician. 2010 Jun;39(6):376-81.
The patient presenting with anal pain, anal lump or rectal bleeding is a common occurrence in the general practice setting and the combination of symptoms usually gives an indication of the most likely diagnosis. However, careful examination including digital rectal examination is always required.
This article discusses three common anorectal conditions: perianal haematoma, haemorrhoids and anal fissure, and briefly discusses the less common, but not to be missed conditions: anal carcinoma and low rectal carcinoma.
The majority of first degree haemorrhoids can be managed by conservative measures alone. More severe degree haemorrhoids require surgical intervention with sclerosant injection, rubber band ligation or surgical haemorrhoidectomy. Initial treatment for anal fissure is with a high fibre diet, faecal softeners, topical local anaesthetic gel and glycerol trinitrate ointment. Botulinim toxin can be injected to create a chemical sphincterotomy, allowing healing. Chronic fissures produce intense and constant pain in the anal region and in these cases surgical sphincterotomy is often necessary to cure the condition, but can result in faecal incontinence. Anal cancer has similar presentation to haemorrhoids and carcinoma of distal rectum can initially present with a haemorrhoid, so the possibility of anorectal cancer should be considered in any patient presenting with haemorrhoids, tenesmus and change in bowel habit.
在全科医疗环境中，出现肛门疼痛、肛门肿物或直肠出血的患者很常见，这些症状的组合通常能提示最可能的诊断。然而，始终需要进行仔细检查，包括直肠指检。
本文讨论三种常见的肛肠疾病：肛周血肿、痔疮和肛裂，并简要讨论较不常见但不可漏诊的疾病：肛管癌和低位直肠癌。
大多数一度痔疮仅通过保守治疗即可。更严重的痔疮需要手术干预，如硬化剂注射、橡皮圈套扎或手术切除痔疮。肛裂的初始治疗包括高纤维饮食、粪便软化剂、局部麻醉凝胶和硝酸甘油软膏。可注射肉毒杆菌毒素进行化学性括约肌切开术，促进愈合。慢性肛裂会在肛门区域产生剧烈且持续的疼痛，在这些情况下，手术括约肌切开术通常是治愈该病所必需的，但可能导致大便失禁。肛管癌的表现与痔疮相似，直肠远端癌最初可能表现为痔疮，因此，任何出现痔疮、里急后重和排便习惯改变的患者都应考虑肛管直肠癌的可能性。
