Anal Fissure

Overview

An anal fissure is a tear in the skin of the anal canal. A fissure most commonly occurs from the trauma of passing a large bowel movement or repeated bowel movements as a result of diarrhea. Occasionally a fissure may be a manifestation of an underlying disease such as Crohn’s Disease.
Symptoms

The most common symptom associated with an anal fissure is pain with having a bowel movement. Bright red blood may also be noted on the stool and toilet paper with wiping.
Testing

An anal fissure is usually diagnosed by physical examination or by inspecting the anal canal with a tube called an anoscope.

Treatment

The fissure will often heal spontaneously over several weeks. Symptomatic treatment with sitz baths, stool softeners and painkillers may be helpful. Medications such as nitroglycerin or calcium channel blockers, which relax the anal sphincter and promote healing are also often effective. An injection of Botulotoxin into the anal sphincter may also promote healing. Fissures that become chronic or fail to respond to these therapies may be cured through surgery. This typically involves excising the fissure and carefully loosening the sphincter muscle to promote healing.

Hemorrhoids

Overview

Hemorrhoids are blood vessels in the anal canal. They are present in all people and act as a cushion and help with normal bowel function and continence. Hemorrhoids can be classified as internal when they occur above the anus and external when they are present outside of the anal canal.
Symptoms

Hemorrhoids may not produce any symptoms in most people. Enlarged internal hemorrhoids can cause painless rectal bleeding. External hemorrhoids may become swollen and painful when a clot forms within the vein. This is a condition called thrombosis.

Testing

Hemorrhoids can typically be diagnosed by physical examination or a limited evaluation of the anal canal with an anoscope or flexible sigmoidoscope or colonoscope.
Treatment

Bleeding internal hemorrhoids will often respond to increase in dietary fiber and fluids. Persistent bleeding may require medicated suppositories. If these measures are ineffective, the hemorrhoids can be treated with rubber band ligation or infrared coagulation. Both are relatively simple and painless office-based procedures. Persistent or prolapsing hemorrhoids may require surgical removal.

Thrombosed external hemorrhoids may respond to conservative measures such as sitz baths and anti-inflammatory creams. Severely painful or refractory thrombosed hemorrhoids may require surgical excision to remove the retained clot.

Colon Polyp

Overview

A colon polyp is a growth on the lining of the colon or rectum. Most polyps are benign. The two most common types of polyps found in the colon are adenomatous and hyperplastic. Adenomatous polyps have the potential to become cancer. Hyperplastic polyps are typically innocent and not pre-cancerous.

Symptoms

Most polyps are small and do not cause any symptoms. Large polyps can cause rectal bleeding or chronic blood loss with resultant anemia. Rarely, large polyps can cause obstruction of the colon.

Testing

Colon polyps are most commonly detected during a colonoscopy. They may also be found with other forms of diagnostic testing, such as a barium enema or virtual CT scan colonoscopy.

Treatment

All polyps should be removed during a colonoscopy. Small polyps can be removed by pinching away the abnormal tissue with an instrument called a biopsy forceps. Larger polyps can be removed using a snare, which is a wire loop. The polyp is grasped with the snare and electrocautery is used to cut through the tissue and cauterize any blood vessels to prevent bleeding. Extremely large polyps may not be amenable to removal using these techniques and may require surgical resection.

Rectal Prolapse

Overview

Rectal prolapse is a condition where a portion of the wall of the rectum prolapses or falls through the anal canal. The rectal tissue can be felt or visualized outside of the anus. This typically occurs after straining to pass a bowel movement. Rectal prolapse is more common in elderly females but may occur at any age and in both sexes.

Symptoms

Symptoms of rectal prolapse include a mucousy discharge, rectal bleeding, incontinence of fecal material and a tissue mass protruding from the anus.

Testing

Diagnosis is most commonly made by physical examination after the patient has strained to pass a stool.

Treatment

Treatment of symptomatic rectal prolapse typically requires surgical repair.