Thrombosed Haemorrhoid Ischiorectal Abscess (Advanced)Īnal pain on defaecation, which typically feels like passing razor blades and often followed by throbbing pain for an hour or two. Thombosed haemorrhoids: are a common cause of acute anal pain and evident externally.Anal malignancy typically is noticed due to bleeding or irritation and may be an ulcer or an ‘odd uneven anal lesion’ akin to a bizarre skin tag. Malignancy: is rarely painful unless it is very advanced (and very obvious).Patients with perianal sepsis should be admitted. There may be fever, tachycardia, deranged BG in diabetics. Patients find PR examination unbearable and have constant pain with recent onset. Sometimes it may not be obvious from the outside (if there is an intersphincteric abscess). Acute perianal sepsis: usually presents with obvious swelling and tenderness starting on one side of the anus but can spread to the other side (horseshoe pattern).In extreme circumstances admission may be required. Secondary fissures are oftenlocated outside of the midline, and if associated with skin changes or inflamed skin tags should raise clinical suspicion of IBD (though is a very rare initial IBD presentation).Īcute anal pain requires a face to face consultation for examination to exclude perianal sepsis or malignancy. Primary fissures are located at the posterior and anterior anal midlines(90% females, 99% males) and are benign. IBD, sexually transmitted infections, sexual abuse, rectal malignancy, drugs( nicorandil is a potential cause of unusual perianal fissuring and ulceration) and pelvic floor disorders. Secondary: Due to underlying cause, e.g.Primary: Believed to be due to spasm after defaecatory trauma and poor perfusion/poor healing.Acute: 6wks a “sentinel tag” may be seen.If diagnostic uncertainty, please see the guideline on " Undiagnosed Rectal Bleeding". This guideline applies to situations where the diagnosis of anal fissure is likely or confirmed.
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