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Common Anorectal Conditions

The National Procedures Institute, Midland, Michigan; and Midland, Michigan

Patients with a wide variety of anorectal lesions present to family physicians. Most can be successfully managed in the office setting. A high index of suspicion for cancer should be maintained and all patients should be questioned about relevant family history or other indications for cancer screening. Patients with condylomata acuminata must be examined for human papillomavirus infection elsewhere after treatment of the presenting lesions. Their sexual partners should also be counseled and screened. Both surgical and nonsurgical treatments are available for the pain of anal fissure. Infection in the anorectal area may present as different types of abscesses, cryptitis, fistulae or perineal sepsis. Fistulae may result from localized infection or indicate inflammatory bowel disease. Protrusion of tissue through the anus may be due to hemorrhoids, mucosal prolapse, polyps or other lesions.

View larger version (109K): [in this window] [in a new window]   Figure 1. Extensive perianal condyloma acuminata (arrow). This condition is generally caused by infection with human papillomavirus 6 or 11.

View larger version (109K): [in this window] [in a new window]   Figure 5. Blood on the end of a cotton-tipped applicator being withdrawn from a fistula that could easily have been missed.

View larger version (72K): [in this window] [in a new window]   Figure 7. Internal hemorrhoids, grade II to III (long arrows). Internal hemorrhoids occur above the dentate (pectinate) line (short arrow). This patient also has some hemorrhoidal tissue at the dentate line.

View larger version (121K): [in this window] [in a new window]   Figure 9. Prolapsed internal hemorrhoids, grade IV (long black arrow). The dentate line (short black arrow) is indicated, and a small polyp (white arrow) is visible.

View larger version (87K): [in this window] [in a new window]   Figure 11. Anal tag (arrow). Anal tags should be removed or a biopsy should be obtained to confirm the etiology. Anoscopy may enable the physician to identify the cause or find other lesions.

View larger version (105K): [in this window] [in a new window]   Figure 15. Anal cancer (arrow). This anal cancer had been treated for three months with steroid suppositories although the patient had never had a physical examination. Simple inspection of the external anal area allowed the physician to identify this aggressive tumor.