Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or non-surgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani.
After lurking about in the wings the required 2 months I have felt the need to tell you about my anal fissure Bob. It all started about two years ago in Thailand. I had just fired a round of green chile liquishit down the hole that the Asians call "toilet" when I noticed an odd sensation just inside the rim of my sphincter accompanied by a blasting spray of rich red blood. After living in Asia for six months I thought that I had experienced nearly every digestive tract malady known to man.
I came upon your web site quite by accident. I have to say that I found it to be quite informative. It's surprising to me how little that most of the physicians that I speak with know about anal fissures. When I originally wrote My Anal Fissure Bob I was just trying to do something that reflected my angst and frustration.