ano-rectal pain

see also:

• perianal abscess
• perirectal abscess
• haemorrhoids
• anal fissure
• anal fistula / fistula-in-ano
• proctitis
• PR_exam

• thrombosed external haemorrhoid
• anal fissure
• perianal abscess
• perirectal abscess
  • ischio-rectal abscess
    • deep abscess within fat of ischiorectal fossa
    • can track to opposite side to form a horseshoe-shaped track
  • submucous abscess following injection of haemorrhoids
  • pelvi-rectal abscess
    • located above levator ani
    • usually follows pelvic cellulitis but may occur as complication of inflammatory bowel disease (IBD), diverticulitis, rectal Ca
• external boil
• pilonidal abscess
  • occur in upper natal cleft
• proctitis
• prostatitis
• traumatic injury / anal foreign body / sexual misadventure
• proctalgia fugax
  • recurring paroxysms of sudden, intense rectal pain usually lasting seconds to minutes
  • usually at night
• levator ani syndrome (LAS)
  • a functional disorder causing chronic or recurrent rectal pain, often described as a dull ache or “sitting on a ball” sensation lasting >20 minutes.
  • often worsen when sitting and improve with walking
  • due to spasm of the pelvic floor muscles
• coccydynia
  • pain and tenderness of the coccyx
• anal Herpes simplex virus (HSV)
• perianal streptococcal dermatitis
  • mainly in children - a bright red, sharply demarcated rash that is caused by group A beta-hemolytic streptococci

• bleeding or prolapsed internal haemorrhoids
• pilonidal sinus
  • occur in upper natal cleft
• anal fistula / fistula-in-ano
• sentinel pile
  • residual skin tag following anal fissure which can create hygiene issues and pruritus ani
• pruritus ani
  • mainly due to dermatoses (see below)
  • in children, commonly due to pinworms which cause itch at night
  • scabies
• anal warts / condylomata acuminata
• other anal skin pathologies
  • skin cancer
    • perianal SCC
      • anal intraepithelial neoplasia (AIN)
        • assoc with HPV 16 and 18, often seen in HIV/AIDS
    • melanoma
    • etc
  • perianal dermatoses:
    • perianal irritant contact dermatitis
      • excessive sweat or moisture
        • inadequate drying after bidet use
      • soaps and cleansers
      • faecal soiling
        • poor hygiene / sentinel pile / anal skin tags
        • overflow incontinence
        • frequent diarrhoea
        • prolonged soiling contact associated with incontinence pads
      • faecal irritants
        • eating spicy foods or taking laxatives such as co-danthrusate
    • allergic contact dermatitis
      • topical creams especially local anaesthetics
      • fragrances eg. in wet wipes, body washes
      • incontinence pads with colophony, acrylates or fragrances
      • rubber (eg. condoms)
      • nail varnish
    • atopic dermatitis
    • seborrhoeic dermatitis
    • lichen simplex
      • from excessive scratching
    • lichen sclerosis
      • usually women, often with associated vulval involvement
      • increased risk of perianal SCC
    • lichen planus
    • flexural psoriasis
    • intertrigo
      • an inflammatory rash in a skin fold, often due to sweat and friction
    • hidradenitis suppurativa
    • pemphigus vulgaris
    • benign familial pemphigus (Hailey-Hailey disease) typically involves skin folds including the skin around the anus.
    • extramammary Paget disease
  • other skin infections
    • erythrasma
      • due to Corynebacterium minutissimum causes painless brown patch with characteristic coral red fluorescence is seen with a Wood lamp
    • candidiasis
      • usually has satellite lesions
    • tinea cruris