Causes of Anorectal disorders
Anorectal disorders Causes: Book Excerpts
Related information on causes of Anorectal disorders:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Anorectal disorders may be found in:
Causes of Anorectal disorders: Online Medical Books
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for more information about the causes of Anorectal disorders.
Hemorrhoids:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
External hemorrhoids
–Located below the pectinate line
–Typically painful
-
Internal hemorrhoids
–Located above the pectinate line
–Typically not painful, unless thrombosis
occurs
-
Pregnancy
–Up to 35% of pregnant females will develop hemorrhoids around the time of delivery, with most cases occurring after a vaginal delivery and/or a prolonged labor
-
Condylomata acuminatum (genital warts)
- Rectal prolapse
–External protrusion of the rectum
–Complete prolapse versus partial full thickness prolapse versus prolapse of mucosa only
–Partial rectal prolapse or mucosa-alone rectal prolapse is typically concentric, thus can be differentiated from internal prolapsing hemorrhoids that tend to have separation between cushions and inflammation
-
Rectal polyp
-
Rectal or anal cancer
-
Hypertrophied anal papilla (polypoid structure at pectinate line)
-
External skin tag
–Redundant fold of tissue along the external anal margin
-
Perirectal abscess
-
Anal fissure or fistula
-
Rectal varices
–Develop secondary to portal hypertension
-
Rectal cavernous hemangioma
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Rectal Pain:
Differential Diagnosis
(In a Page: Signs and Symptoms)
- Anal fissure
–Acute fissure presents with pain and bleeding (noticed on toilet paper) immediately following defecation
–Chronic fissure presents with long-standing itching and mild pain, with or without bleeding
-
Perianal abscess (with or without associated fistula formation
-
Thrombosed hemorrhoid
-
Levator ani syndrome
-
Proctalgia fugax (rectal muscle spasm)
-
Coccyodynia/coccygodynia
-
Fecal impaction
-
Neoplasm (rectal, pelvic, or cauda equina)
-
Idiopathic
-
Inflammatory bowel disease (ulcerative proctitis, Crohn's disease)
-
Solitary rectal ulcer syndrome
–Misnomer: May be multiple, not restricted to rectum, and lesion may be polypoid
–Neoplasm is a concern
-
Pruritus ani
-
Trauma
-
Anal sex
-
Constipation
-
Diarrhea
-
Less common causes (“zebras”) include familial rectal pain, endometriosis, pelvic inflammatory disease, prostatitis, myopathies, foreign bodies, and compression or inflammation of sacral nerves
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Rectal pain:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Abscess (perirectal)
A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that’s exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, commonly high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as a fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Anal fissure
An anal fissure is a longitudinal crack in the anal lining that causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula
Pain develops when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus and, occasionally, stool.
Hemorrhoids
Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient’s fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Hemorrhoids:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Hemorrhoids probably result from increased venous pressure in the hemorrhoidal plexus. Predisposing factors include occupations that require prolonged standing or sitting; straining due to constipation, diarrhea, coughing, sneezing, or vomiting; heart failure; hepatic disease, such as cirrhosis, amebic abscesses, or hepatitis; alcoholism; anorectal infections; loss of muscle tone due to old age, rectal surgery, or episiotomy; anal intercourse; and pregnancy.
Hemorrhoids are more common in whites, in persons of higher socioeconomic classes, and in persons who live in rural areas. However, actual incidence figures are unknown because many patients with hemorrhoids self-medicate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Anorectal abscess and fistula:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
The inflammatory process that leads to abscess may begin with an abrasion or tear in the lining of the anal canal, rectum, or perianal skin and subsequent infection by Escherichia coli, staphylococci, or streptococci. Trauma may result from injections for treatment of internal hemorrhoids, enema-tip abrasions, puncture wounds from ingested eggshells or fish bones, or insertion of foreign objects. Other preexisting lesions include infected anal fissure, infections from the anal crypt through the anal gland, ruptured anal hematoma, prolapsed thrombosed internal hemorrhoids, and septic lesions in the pelvis, such as acute appendicitis, acute salpingitis, and diverticulitis. Systemic illnesses that may cause abscesses include ulcerative colitis and Crohn’s disease. However, many abscesses develop without preexisting lesions.
As the abscess produces more pus, a fistula may form in the soft tissue beneath the muscle fibers of the sphincters (especially the external sphincter), usually extending into the perianal skin. The internal (primary) opening of the abscess or fistula is usually near the anal glands and crypts; the external (secondary) opening, in the perianal skin.
The peak incidence of anorectal abscess occurs in people in their 30s and 40s, but there’s also a high occurrence in infants. Men are affected two to three times more often than women. About 30% of patients have a previous history of abscess.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Anorectal stricture:
Causes
(Professional Guide to Diseases (Eighth Edition))
Anorectal stricture results from scarring after anorectal surgery or inflammation, inadequate postoperative care, or laxative abuse.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Rectal pain:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Abscess (perirectal)
This abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that’s exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, often high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Abscess (prostatic)
This disorder occasionally produces rectal pain. Common associated findings include urine retention and frequency, dysuria, and fever. A rectal examination may reveal prostatic tenderness and gas.
Anal fissure
This longitudinal crack in the anal lining causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula
Pain develops when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus, and occasionally stool.
Cryptitis
This disorder results when particles of stool that are lodged in the anal folds decay and cause infection, which may produce dull anal pain or discomfort and anal pruritus.
Hemorrhoids
Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient’s fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
Proctalgia fugax
With this disorder, muscle spasms of the rectum and pelvic floor produce sudden, severe episodes of rectal pain that last up to several minutes and then disappear. The patient may report being awakened by the pain, which is sometimes associated with stress or anxiety and relieved by food and drink.
Rectal cancer
Rectal pain, bleeding, tenesmus, and a hard, nontender mass are typical findings in this rare form of cancer.
Other causes
Anal intercourse
Shearing forces may cause inflammation or tearing of the mucous membranes and discomfort.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Rectal Pain:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Hemorrhoid
❑ Rectal fissure
❑ Prostatitis
❑ Anal fistula
❑ Pruritus ani
❑ Fecal impaction
❑ Coccydynia
❑ Perirectal abscess
❑ Infected pilonidal cyst
❑ Ulcerative proctitis
❑ Infective proctitis
❑ Proctalgia fugax
❑ Anal carcinoma
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Hemorrhoids:
Causes
(Handbook of Diseases)
Hemorrhoids result from activities that increase intravenous pressure, resulting in distention and engorgement. Predisposing factors include prolonged sitting, straining at defecation, constipation, low-fiber diet, pregnancy, and obesity.
Other factors include hepatic disease, such as cirrhosis, amebic abscesses, or hepatitis; alcoholism; and anorectal infections.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Rectal pain:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Abscess
A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing, local pain that’s exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously high in the rectum or even in the lower abdomen and is accompanied by an indurated anal mass. The patient may also develop such associated signs and symptoms as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
A prostatic abscess occasionally produces rectal pain. Common associated findings include urine retention and frequency, dysuria, and fever. A rectal examination may reveal prostatic tenderness and gas.
Anal fissure
An anal fissure is a longitudinal crack in the anal lining that causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula
Pain develops when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints of an anorectal fistula include pruritus and drainage of pus, blood, mucus and, occasionally, stool.
Cryptitis
Cryptitis results when particles of stool that are lodged in the anal folds decay and cause infection, which may produce dull anal pain or discomfort and anal pruritus. Intense pain may occur when the anal sphincter contracts.
Hemorrhoids
Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient’s fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
Proctalgia fugax
With proctalgia fugax, muscle spasms of the rectum and pelvic floor produce sudden, severe episodes of rectal pain that last up to several minutes and then disappear. The patient may report being awakened by the pain, which is sometimes associated with stress or anxiety and relieved by food and drink.
Other causes
Anal intercourse
Shearing forces may cause inflammation or tearing of the mucous membranes and discomfort.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Rectal pain:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Abscess (perirectal).A perirectal abscess can occur in various locations in the rectum and anus, causing pain in the perianal area. Typically, a superficial abscess produces constant, throbbing local pain that's exacerbated by sitting or walking. The local pain associated with a deeper abscess may begin insidiously, commonly high in the rectum or even in the lower abdomen, and is accompanied by an indurated anal mass. The patient may also develop associated signs and symptoms, such as fever, malaise, anal swelling and inflammation, purulent drainage, and local tenderness.
Anal fissure.An anal fissure causes sharp rectal pain on defecation. The patient typically experiences a burning sensation and gnawing pain that can continue up to 4 hours after defecation. Fear of provoking this pain may lead to acute constipation. The patient may also develop anal pruritus and extreme tenderness and may report finding spots of blood on the toilet tissue after defecation.
Anorectal fistula.Anorectal fistula causes rectal pain to develop when a tract formed between the anal canal and skin temporarily seals. It persists until drainage resumes. Other chief complaints include pruritus and drainage of pus, blood, mucus and, occasionally, stools.
Hemorrhoids.Thrombosed or prolapsed hemorrhoids cause rectal pain that may worsen during defecation and abate after it. The patient's fear of provoking the pain may lead to constipation. Usually, rectal pain is accompanied by severe itching. Internal hemorrhoids may also produce mild, intermittent bleeding that characteristically occurs as spotting on the toilet tissue or on the stool surface. External hemorrhoids are visible outside the anal sphincter.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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