Abstract
Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from
the perianal region, which are highly prevalent symptoms in the general population.
Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes, and pruritus
anii are the most common clinical disorders. Well-trained physicians, irrespective
of their specialty, can treat most of these disorders and refer them to a specialist
in proctology only when necessary. The aim of this review is to provide a practical
guide to the management of benign anorectal disorders in terms of their initial management
and the criteria for specialist referral.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of benign anorectal disease in a randomly selected population.Dis Colon Rectum. 1995; 38 (7): 341-344
- Functional anorectal disorders.Gastroenterology. 2016; 130: 1510-1518
- Common anorectal conditions: part I. Symptoms and complaints.Am Fam Physician. 2001; 63: 2391-2398
- Development of a validated questionnaire evaluating the burden of the haemorrhoidal disease and anal fissure (hemo-fiss).Value Health. 2015; 18: A630
- Practice parameters for the management of hemorrhoids (revised 2010).Dis Colon Rectum. 2011; 54: 1059-1064
- Anorectal disorders.Gastroenterology. 2016; 150 (e4): 1430-1442
- [Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care].Aten Primaria. 2009; 41 (in Spanish): 207-212
- ACG clinical guideline: management of benign anorectal disorders.Am J Gastroenterol. 2014; 109 (Quiz) 1058: 1141-1157
- Value of symptoms and additional diagnostic tests for colorectal cancer in primary care: systematic review and meta-analysis.BMJ. 2010; 340: c1269
- Hemorrhoids.N Engl J Med. 2014; 371: 944
- Anal fissure.Clin Colon Rectal Surg. 2016; 29: 30-37
- Anorectal pain, bleeding and lumps.Aust Fam Physician. 2010; 39: 376-381
- Prospective analysis of clinician accuracy in the diagnosis of benign anorrectal pathology: the value of clinical information.Rev Esp Enferm Dig. 2012; 104: 122-127
- ACG clinical guideline: management of Benign anorectal disorders.Am J Gastroenterol. 2014; 109 (Available at:): 1141-1157http://www.nature.com/doifinder/10.1038/ajg.2014.190Date accessed: November 24, 2016
- Evaluation and management of common anorectal conditions.Am Fam Physician. 2012; 85: 624-630
- Is earlier referral and investigation of bowel cancer patients presenting with rectal bleeding associated with better survival?.Colorectal Dis. 2011; 13: 1242-1248
- Benign anorectal disease: definition, characterization and analysis of treatment.Am J Gastroenterol. 1994; 89: S182-S193
- Anorectal disorders.Am J Gastroenterol. 2010; 105: 786-794
- What every gastroenterologist needs to know about common anorectal disorders.World J Gastroenterol. 2009; 15: 3201-3209
- Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer.Br J Cancer. 2010; 102 (Available at:): 48-58http://www.nature.com/doifinder/10.1038/sj.bjc.6605426Date accessed: November 30, 2016
- Anorectal anatomy and imaging techniques.Gastroenterol Clin North Am. 2013; 42: 701-712
- The pathogenesis of hemorrhoids.Dis Colon Rectum. 1984; 27: 442-450
- Reducing the incidence and mortality of colon cancer: mass screening and colonoscopic polypectomy.Gastroenterol Clin North Am. 2008; 37: 129-160
- Practice parameter for the detection of colorectal neoplasms: an interim report (Revised).Dis Colon Rectum. 2006; 49: 299-301
- Practice parameters for the management of rectal prolapse.Dis Colon Rectum. 2011; 54: 1339-1346
- Classification of internal haemorrhoids: a discussion paper.Colorectal Dis. 2004; 6: 226-232
- The prevalence of hemorrhoids in adults.Int J Colorectal Dis. 2012; 27: 215-220
- Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis.Am J Gastroenterol. 2006; 101: 181-188
- Conservative management of symptomatic and/or complicated haemorrhoids in pregnancy and the puerperium.Cochrane Database Syst Rev. 2005; (CD004077)
- Laxatives for the treatment of hemorrhoids.Cochrane Database Syst Rev. 2005; (CD004649)
- Flavonoids mixture (diosmin, troxerutin, hesperidin) in the treatment of acute hemorrhoidal disease: a prospective, randomized, triple-blind, controlled trial.Tech Coloproctol. 2015; 19: 339-345
- Phlebotonics for haemorrhoids.Cochrane Database Syst Rev. 2012; (CD004322)
- Diagnosis and management of symptomatic hemorrhoids.Surg Clin North Am. 2010; 90: 17-32
- Comparison of hemorrhoidal treatments: a meta-analysis.Can J Surg. 1997; 40: 14-17
- Comparison of hemorrhoidal treatment modalities. A meta-analysis.Dis Colon Rectum. 1995; 38: 687-694
- Excision of thrombosed external hemorrhoid under local anesthesia: a retrospective evaluation of 340 patients.Dis Colon Rectum. 2003; 46: 1226-1231
- Thrombosed external hemorrhoids: outcome after conservative or surgical management.Dis Colon Rectum. 2004; 47: 1493-1498
- Non surgical therapy for anal fissure.Cochrane Database Syst Rev. 2006; (CD003431)
- Practice parameters for the management of anal fissures (3rd revision).Dis Colon Rectum. 2010; 53: 1110-1115
- Re-examination of clinical manifestations and response to therapy of fissure-in-ano.Dis Colon Rectum. 1997; 40: 229-233
- Prospective analysis of clinician accuracy in the diagnosis of benign anal pathology: comparison across specialties and years of experience.Dis Colon Rectum. 2010; 53: 47-52
- The conservative treatment of fissure-in-ano.Br J Surg. 1983; 70: 175-176
- Practice parameters for the management of anal fissures (3rd revision).Dis Colon Rectum. 2010; 53: 1110-1115
- Systematic review of the use of topical diltiazem compared with glyceryltrinitrate for the nonoperative management of chronic anal fissure.Colorectal Dis. 2013; 15: 19-26
- Perianal versus endoanal application of glyceryl trinitrate 0.4% ointment in the treatment of chronic anal fissure.Dis Colon Rectum. 2012; 55: 893-899
- Anal abscess and fistula.Gastroenterol Clin North Am. 2013; 42: 773-784
- Multicentre observational study of outcomes after drainage of acute perianal abscess.Br J Surg. 2016; 103: 1063-1068
- Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula.Dis Colon Rectum. 2016; 59: 1117-1133
- Perianal abscess: a pilot study comparing packing with nonpacking of the abscess cavity.Dis Colon Rectum. 2004; 47: 1510-1514
- MRSA-related perianal abscesses: an underrecognized disease entity.Dis Colon Rectum. 2007; 50: 996-1003
- Routine operative swab cultures and post-operative antibiotic use for uncomplicated perianal abscesses are unnecessary.ANZ J Surg. 2014; 87: 356-359
- Routine antibiotics for anorectal abscess: the answer is still no.Dis Colon Rectum. 2011; 54: 917-918
- A classification of fistula-in-ano.Br J Surg. 1976; 63: 1-12
- Pathogenesis and treatment of fistula in ano.Br J Surg. 2011; 98: 2-3
- Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial.Trials. 2015; 16: 366
- Pro-inflammatory cytokines in cryptoglandular anal fistulas.Tech Coloproctol. 2016; 20 (Available at:): 619-625http://link.springer.com/10.1007/s10151-016-1494-7Date accessed: November 12, 2016
- Perianal abscesses and fistulas. A study of 1023 patients.Dis Colon Rectum. 1984; 27: 593-597
- The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration.Dis Colon Rectum. 1984; 27: 126-130
- The outcome of fistulotomy for anal fistula at 1 year: a prospective multicentre French study.Colorectal Dis. 2016; 18: 279-285
- Anal fistula surgery. Factors associated with recurrence and incontinence.Dis Colon Rectum. 1996; 39: 723-729
- Emerging treatments for complex perianal fistula in Crohn's disease.World J Gastroenterol. 2009; 15: 4263-4272
- The Snug Seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae.Colorectal Dis. 2006; 8: 328-337
- Functional and chronic anorectal and pelvic pain disorders.Gastroenterol Clin North Am. 2008; 37: 685-696
- Condyloma and other infections including human immunodeficiency virus.Surg Clin North Am. 2010; 90: 99-112
- Anal human papillomavirus infection: prevalence, diagnosis and treatment of related lesions.Expert Rev Anti Infect Ther. 2016; 14: 465-477
- Anorectal disease in HIV-infected patients.Dis Colon Rectum. 1998; 41: 1367-1370
- Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic.Br J Surg. 1999; 86: 1337-1340
Article info
Publication history
Published online: February 27, 2018
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to information included in the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.