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Coloproctology pp 33–61Cite as

Anal Disorders

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Part of the book series: European Manual of Medicine ((EUROMANUAL))

Abstract

4.1

The corpus cavernosum recti is part of the normal anatomy. If this tissue enlarges we speak of haemorrhoids; if it causes symptoms it is a haemorrhoidal disease. The circumstances under which they become symptomatic are not fully understood. Currently, diseases of the haemorrhoids are classified under the chapter of vascular diseases in the International Code of Diseases (e.g. ICD10). However, there is growing consensus that the pathological mechanism involves prolapse of redundant and detached rectal mucosa, which at defaecation slides into the anal canal together with the haemorrhoids. Its impaction in the anal canal during defaecation appears to be the circumstance that generates the symptoms. The therapeutic aim is to prevent the prolapse with one of several treatment options.

4.2

Anal fissure is a common anorectal condition characterised by an acute or chronic linear ulcer in the squamous epithelium of the anus. The aetiology is not completely understood (chronic posterior anal ischaemia and internal anal sphincter spasm are the most accredited theories). Severe pain during and post defaecation is the most important symptom and a gently clinical examination achieves a secure diagnoses. Manometry of the anal sphincters could be useful in the evaluation of anal spasm. Conservative care of fissure includes diet therapy, local anaesthetic ointments, anal dilatations, chemical sphincterotomy (i.e. nitric oxide donors), Calcium channel antagonist and Botulinum Toxin A. Surgical treatment may be offered as primary choice, without being an overtreatment. Depending from the techniques used, postoperative incontinence ranges from 2% to 28%, and recurrence from 0% to 13%. The surgical options include: Posterior Anal Sphincterotomy (to be only used with concomitant posterior intersphinteric fistulae), Fissurectomy, Lateral Internal Sphincterotomy (the most used and affected by low incontinence rate), and Y-V Anal Advanced Flap (used in recurrent chronic fissures and in patient without an increased anal pressure to avoid sphincterotomy).

4.3

A perianal abscess, not related to Crohn’s disease, originates in one of the anal glands. These glands are located in the subepithelial layer of the anal canal at the level of the dentate line. The duct of each gland ends in one of Morgagni’s crypts. Obstruction of a duct, caused by faecal material, foreign bodies or trauma, may result in stasis and infection.

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Chapter 4.1

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Authors and Affiliations

  1. Department for Medical and Surgical Gastroenterology, Karolinska University Hospital - Huddinge, 141 86, Stockholm, Sweden

    Per-Olof Nyström

  2. Colorectal Surgery, Department of Surgery, University Hospital, 581 85, Linköping, Sweden

    Roger Gerjy

  3. Coloproctology Unit, Villa Flaminia Hospital, Via Bodio 58, 00191, Rome, Italy

    Mario Pescatori

  4. Policlinico Gemelli - Department of Surgery, Catholic University, 00191, Rome, Italy

    Claudio Mattana

  5. Department of Surgery, H1043, University Hospital Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands

    W. R. Schouten

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  1. Per-Olof Nyström
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  5. W. R. Schouten
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Editors and Affiliations

  1. Enddarm-Zentrum Mannheim, Bismarckplatz 1, 68165, Mannheim, Germany

    Alexander Herold

  2. Institut des Maladies de l’Appareil Digestif, Clinique Chirurgicale, Hôtel-Dieu, Place Ricordeau, 44093, Nantes Cedex, France

    Paul-Antoine Lehur

  3. Chirurgische Klinik, Universitätsklinikum Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany

    Klaus E. Matzel

  4. University College Dublin, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland

    P. Ronan O'Connell

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Nyström, PO., Gerjy, R., Pescatori, M., Mattana, C., Schouten, W. (2008). Anal Disorders. In: Herold, A., Lehur, PA., Matzel, K., O'Connell, P. (eds) Coloproctology. European Manual of Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-71217-6_4

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