Perianal Lesions

Pruritus Ani
Pruritus ani, characterised by itching around the anal area, can be primary (idiopathic) or secondary to conditions such as dermatological disorders, infections or infestations (such as threadworms), or systemic diseases. Treatment depends on the cause. In idiopathic cases, management includes advising patients on gentle cleaning, avoiding irritants, and the application of topical treatments like emollients or mild steroids for short periods.

Anal Fissures
Anal fissures present as painful tears in the anal mucosa, often associated with bright red rectal bleeding and pain during bowel movements. Initial management focuses on relieving constipation using bulking agents, stool softeners, or laxatives, alongside topical anaesthetics or glyceryl trinitrate ointment to reduce sphincter spasm. Chronic fissures may require referral for surgical options such as lateral internal sphincterotomy.

Haemorrhoids, or piles, are vascular structures in the anal canal that can become swollen, causing discomfort, bleeding, and sometimes prolapse. Conservative management includes dietary adjustments to prevent constipation, and topical treatments (such as corticosteroid creams or suppositories) to reduce symptoms. More severe cases may benefit from minimally invasive procedures like banding, or surgery in refractory cases.

Skin Tags
Perianal skin tags are soft, flesh-coloured flaps of tissue around the anus. They are usually asymptomatic and benign. Treatment is not necessary unless they cause hygiene problems or discomfort. If removal is desired for symptomatic or cosmetic reasons, surgical excision under local anaesthesia is the preferred method.

Warts (Condyloma Acuminata)
Anal warts are caused by the human papillomavirus (HPV) and manifest as soft, moist bumps around the anal area. Treatment options include topical agents like imiquimod, podophyllotoxin, or surgical methods such as cryotherapy, electrocautery, or excision for larger or resistant warts. This is best arranged through local STI clinics, which can also screen for other relevant infections.

Anal Cancer
Anal cancer is relatively rare and may present with non-specific symptoms such as rectal bleeding, a lump near the anus, or pain. Management typically involves a combination of chemotherapy and radiotherapy for localised disease. Surgery is reserved for specific cases or recurrent disease (.

Perianal Haematoma
A perianal haematoma, often described as an external thrombosed haemorrhoid, presents as a sudden, painful, swollen, blue-tinted lump near the anal margin. Treatment usually involves pain relief, with cold compresses and analgesia. In acute cases, surgical evacuation of the clot can provide immediate relief.

Perianal Abscess
This is characterised by a collection of pus near the anus, leading to severe pain, swelling, and sometimes fever. Management typically involves urgent referral for incision and drainage under general anaesthesia. Antibiotic therapy is indicated if there are signs of systemic infection or the patient is immunocompromised.

Anal Fistula
An anal fistula is an abnormal tract connecting the anal canal to the skin near the anus, often resulting from previous abscesses. Symptoms include discomfort, discharge, and recurrent abscesses. Management usually involves surgical intervention to open and drain the fistula. Complex fistulas may require more specialised surgical techniques. They can be a complication of Crohn’s disease.


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