The sensitivity of the anoderm and the risk of injuring this important and sensitive area by using inappropriate measures should be emphasized here again.įig. In addition to the time course, the patient’s symptoms should therefore also be taken into account, as well as possible comorbidities (e.g., with anticoagulant medication). An incision should therefore only be carried out within the first few days, and the ideal cut-off point is between 1 and 3–4 days. The greater the time between the development of the condition and presentation to the physician, organization of the thrombus can occur that makes it more difficult to provide relief with an incision. The time of diagnosis is decisive for treatment. Treatment of anal venous thrombosis is based on the time course and the extent of the symptoms. If the findings are unclear, we would therefore recommend proctoscopy and differentiation from the hemorrhoid complex. In the differential diagnosis, it needs to be distinguished from a thrombosed hemorrhoid and incarcerated anal prolapse, but even experienced colleagues may sometimes find it difficult to distinguish from a thrombosed hemorrhoid. The visible thrombus is painful to the touch, usually has a taut consistency, and is covered with anoderm. The diagnosis is easy and can be made by inspecting the anal region. A distinction is made between an isolated thrombus and multiple perianal thromboses such as those that often occur during pregnancy. 1), and is therefore located in the area of the anoderm. Table 1?Frequent causes of anal painĪnal venous thrombosis is caused by a thrombus in the external anal venous plexus (Fig.

Neuropathic pain also needs to be considered - e.g., in the context of herpes infection or functional disturbances such as proctalgia fugax. Anal abscesses are also occasionally a cause of anal pain, but they usually develop slowly and involve dull pain. The differential diagnosis includes incarcerated anal prolapse and thrombosed hemorrhoids, but these tend to cause less pain. Whereas the intensity of pain in anal venous thrombosis declines over the course of a few days, in the case of anal fissure the pain declines over a period of hours, but starts again with every subsequent bowel movement and is usually described as being much more intense. The most frequent causes of acute anal pain are anal venous thrombosis and anal fissure.īoth types of pain are described as being “epicritic” - i.e., they are intense in nature and are clearly localizable. Both of these conditions typically result from difficult defecation with heavy straining (anal venous thrombosis) or constipation due to a hard fecal consistency (anal fissure). The most frequent causes of a pain-related presentation to the proctologist are anal venous thrombosis and anal fissure. For this reason, and to provide practical guidance, we have therefore decided in this part to classify proctological treatment on the basis of the symptoms the patient presents with at the hospital or at the physician’s office. Once the patient history has been carefully taken, it makes it possible to establish the diagnosis in many cases, or to narrow the possible causes down to a small number. In the first part of this article we have already discussed diagnosis and emphasized the importance of patient history in proctology.

When a patient comes to the doctor with acute anal pain ….

Sentinel skin tag