Anal/Rectal Diseases

Anal or Rectal Abscess

Abscesses are pus collection from bacterial invasion and occur in the intermuscular space where a crypt has formed. The two types are superficial (near the surface), and deep. Superficial abscesses may be painful with swelling, redness, or tenderness. Deep abscesses sometimes produce toxic symptoms with less severe pain. Abscesses formed in the higher regions of the rectum may cause lower abdominal pain or fever, and are sometimes associated with inflammatory bowel diseases.

Treatment is by incision and drainage. Antibiotics have limited usefulness in those patients who are febrile, diabetic, or have developed a systemic infection.

Anal Atresia

Anal atresia is a congenital anomaly in which the anus is not formed appropriately to function properly. If it is unnoticed on physical exam, it becomes apparent after feeding, with symptoms of distal bowel obstruction. In infant males, a fistula (tube) is formed that reaches from the anal pouch to the perineum or urethra. In infant females, the fistula reaches from the anal pouch to the vagina, fourchette, or urethra.

Testing is done by collecting and filtering the urine to test for meconium (first discharge from the bowels). Treatment of cutaneous fistulas can be corrected by surgery, higher lesions should not be treated until the infant is older, the structures involved are larger, and temporary relief of obstruction is accomplished by colostomy.

Bleeding

The passage of blood through the rectum, called hematochezia, often indicates lower gastrointestinal tract source and black tarry stool, called melena, is a typical indication of upper gastrointestinal tract source. Gastrointestinal bleeding may result from various diseases, diverticular diseases, colonic carcinoma, polyps, inflammatory bowel disease, internal hemorrhoids, and anal fissures.

Diagnosis includes a complete history and physical, and a chemical test to detect the presence of occult blood in the stool. A digital rectal exam can determine the presence of masses, fissures, and hemorrhoids. Sigmoidoscopy will show evidence of hemorrhoids, infectious bowel disease, polyps, and cancer. A colonoscopy will help detect polyps, ulcers, and tumors.

[Page 130]Most lower gastrointestinal tract bleeding does not require emergency therapy. Treatment for severe bleeding includes preventing complications of blood loss, stabilizing the blood pressure, and supplying blood through transfusion if the patient is at risk for further hemorrhage. To stop bleeding in emergency situations, coagulation, laser treatment, and surgery may be necessary. Once the patient is stable and the cause of bleeding is diagnosed, treatment will proceed for the specific disease.

Cancer

The uncontrolled growth of cells common types in anorectal cancer include adenocarcinoma, melanoma, and lymphoma, with the potential for these cells to metastasize and spread to other parts of the body. The incidence of colorectal cancer increases after the age of 40 and peaks between ages 60 and 75. Adenocarcinoma grows slow with a long interval before symptoms appear. A positive test for occult blood indicates further testing. A colonoscopy is used to diagnose cancer, although no specific blood test for colorectal cancer exists, the serum levels of tumor markers may be elevated.

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