Anal Region Abnormalities
Pilonidal Cyst or Sinus
A hair-containing cyst or sinus location in the midlines over the
coccyx or lower sacrum. Often opens as a dimple with visible tuft of
hair and possibly an erythematous halo. Or may appear as a palpable
cyst. When advanced, has a palpable since tract. Although a congenital
disorder, it is first Dx between 15-30 y/o
Anal Region Abnormalities
Anorectal Fistula
A chronically inflamed GI tract (Crohn disease, local irradiation)
create an abnormal passage from inner anus or rectum out to skin
surrounding anus. May result from a local abscess.
The red, raised tract opening may drain serosanuineous or purulent
matter when pressure is applied. Bidigital palpation may reveal an
indurated cord. May heal with warm batch, high-fiber diet, and analgesics.
Anal Region Abnormalities
Fissure
An exquisitely painful longitudinal tear in the superficial mucosa at
the anal margin. Most (90%) occurring the posterior midline area.
Pain is described as passing "shards of glass"; may have
bright red blood in the stool.
A resulting spasm in the sphincters makes the area painful to
examine. Inspection shows a recent issue has haring sharp edges.
A chronic fissure as indurated and accompanied by a papule of skin,
sentinel tag, on the anal margin below or a polyp above.
Fissures may be caused by trauma (passing a large hard stool) or
form irritant diarrheal stools.
Tx with stool softeners, fiber, warm soaking baths, topical analgesics.
Healing may be enhanced with topical nitroglycerin ointment or
Botox injection
Anal Region Abnormalities
Hemorrhoids
These painless, flabby papule are caused by varicose veins.
External hemorrhoid starts below the anorectal junction and is
covered by anal skin.
When thrombosed, it contains clotted blood and
becomes painful, swollen, shiny blue mass that itches and bleeds with
defecation. When it resolves, it leaves a painless, flabby skin sac
around the anal orifice.
Internal hemorrhoid start above the anorectal junction and is
covered by mucous membrane.
When the person forms a Valsalva maneuver, it may appear as a red
mucosal mass.
All hemorrhoids result from increased portal venous pressure: as
occurs with straining at stool, chronic constipation, pregnancy,
obesity, chronic liver disease, or the low-fiber diet common in
Western society.
Anal Region Abnormalities
Rectal Prolapse
The complete rectal mucous membrane protrudes through the anus,
appearing as a moist red doughnut with radiating lines.
When prolapse is incomplete, only mucosa bulges.
When complete, it include the anal sphincters.
Occurs following a Valsalva maneuver such as straining at stool or
with exercise.
Caused by weakened pelvic support muscles and requires surgery
Anal Region Abnormalities
Pruritus Ani
Intense perianal itching is caused by pinworm infection in children
and institutionalized adults and by prolapsed hemorrhoids, anal
fissure, dermatitis, chronic diarrhea, poor hygiene, perfume or dye
irritants, systemic disease such s DM or IBD.
Inspection shows red, raised, thickened excoriated skin around the
anus. The area is swollen and moist.
With fungal infection it appears dull grayish pink.
Treat the underlying cause; encourage good hygiene, use topical
steroid cream
Rectum Abnormalities
Abscess
A localized cavity of pus from infection in the pararectal space.
Infection usually extends from an anal crypt.
Characterized by persistent throbbing rectal pain. Termed by the
space it occupies (e.g., perianal abscess is superficial around the
anal skin) and appears red, hot, swollen, indurated, and tender.
An ischiorectal abscess is deep and tender
bidigital palpation; occurs laterally between the anus and ischial
tuberosity and is rare.
Must be rained before it worsens or develops sepsis.
Rectum Abnormalities
Rectal Polyp
A protruding growth from the rectal mucous membrane that is fairly
common. the poly may be pedunculated (on
the stalk) or sessile (a mound on the
surface, close to the mucosal wall).
The soft nodule is difficult to palpate. Colonoscopy and biopsy are
needed to screen for a malignant growth.
Removal of adenomatous polyps has been shown to prevent deaths from
colorectal cancer.
Rectum Abnormalities
Fecal Impaction
A complete colon blockage by hard, desiccated immovable stool in the
rectum, which presents as constipation or overflow incontinence.
Results from decreased bowel motility as in hospitalized older
adults and people with spinal cord injuries; also with low-fiber diet,
hypothyroidism, opiate use.
Abd palpation or DRE reveals mass.
Treat with laxatives, enemas, suppositories.
Community-dwelling older adults are at risk, especially those with
dementia who cannot communicate. Use extreme caution in treating this group.
Rectum Abnormalities
Carcinoma
A malignant neoplasm in the rectum is asymptomatic, this the
importance of routine DRE.
An early lesion may be a single firm nodule. You may palpate an
ulcerated center with rolled edges. As the lesion grows it has an
irregular cauliflower shape and is fixed and stone-hard.
Refer a person with any rectal lesion for cancer screening.
Suggest screening guidelines: careful family Hx, fecal occult blood
tests annually, and colonoscopy every 10 years, staring at age 50
years for those at average risk
Prostate Gland Abnormalities
Benign Prostatic Hypertrophy (BPH)
S: Urinary frequency, urgency, hesitancy, straining to urinate, weak
stream, intermittent stream, sensation of incomplete emptying, nocturia
O: A symmetric nontender enlargement; commonly occurs n makes
beginning in the middle years. The prostate surface feels smooth,
rubbery, or fit (like the consistency of a use), with the median
sulcus obliterated.
Prostate Gland Abnormalities
Prostatitis
S: Fever, chills, malaise, urinary frequency and urgency, dysuria,
urethral discharge; dull, aching pain in perineal and rectal area
O: An exquisitely tender enlargement is acute
inflammation, yielding a swollen, slightly asymmetric gland
With chronic inflammation the signs can vary from tender
enlargement with a boggy feel to isolated firm areas cured by
fibrosis. Or the gland may feel normal.
Prostate Gland Abnormalities
Carcinoma
S: Frequency, nocturia, hematuria, weak stream, hesitancy, pain or
burning on urination; continuous pain in lower back, pelvis, thighs
O: A malignant neoplasm often starts as a single hard nodule on the
posterior surface, producing asymmetry and a change in consistency. As
it invades normal tissue, multiple hard nodules appear, or the entire
gland fields stone-hard and fixed. The median sulcus is obliterated.