Perianal Inspection
October 29th, 2020
On this page:Perianal RashPerianal BloodFissure in AnoPerianal Sinus / FistulaPerianal MassesHaemorrhoids
Perianal Rash
Look For
- Erythematous patches or plaques over the perianal area.
Causes of Perianal Rash
- Dermatoses - contact dermatitis, atopic dermatitis, seborrhoeic dermatitis, psoriasis, vitiligo
- Infection - Staphylococcus, Streptococcus, Corynebacterium, Candida, pinworm
- Crohn's disease
- Extramammary Paget's disease
- Dysplasia secondary to HPV
Perianal Blood
Look For
- Bright red blood over the perianal area.
Causes of Perianal Blood
Perianal
- Haemorrhoids
- Anal tumour - squamous cell carcinoma, basal cell carcinoma, Paget's disease
- Fistula in ano
- Fissure in ano
Colorectal
- Colorectal cancer
- Colorectal polyp
- Colitis - IBD, infection, diverticulitis
- Radiation proctitis / colitis
- Angiodysplasia
- Trauma
Fissure in Ano
Look For
- Tears in the anal opening.
Causes of Fissure in Ano
- Constipation - large / hard stool, straining
- Chronic diarrhoea
- Crohn's disease
- Childbirth
- Infection - abscess, syphilis, tuberculosis, herpes
- Haemorrhoids
- Anal tumour
Perianal Sinus / Fistula
Look For
- One or more openings in the perianal area that may be associated with discharge of blood, pus or faecal material.
Significance
- Pilonidal sinus: a blind-ending tract opening from the anus, which may be associated with an underlying cyst.Infected damaged hair follicle
- Fistula in ano: an abnormal connection between the perianal area and the anus, rectum, vagina or other pelvic organ.Anorectal abscess, Crohn's disease, diverticulitis, tumour, tuberculosis
Perianal Masses
Look For
- A mass around or protruding from the anus.
Causes of Perianal Mass
- Haemorrhoid (prolapsed / thrombosed)
- Rectal prolapse
- Condyloma acuminatum (anal warts)
- Skin tag
- Tumour - squamous cell carcinoma, basal cell carcinoma, mucinous adenocarcinoma, Paget's disease
- Perianal abscess
Haemorrhoids
Haemorrhoids are cushions of anal vascular tissue that may bleed, prolapse, thrombose or cause pain / pruritis.
Look For
- Perianal or rectal mass - flesh / mucosal appearance
- Thrombosed mass - purple or blue, may be associated with overlying clot
- Blood
- Mucus discharge
Severity
- First degree - non-prolapsed
- Second degree - prolapse and reduce spontaneously
- Third degree - reduce with manual pressure
- Fourth degree - unable to be reduced
Risk Factors for Haemorrhoids
- Straining while defaecating
- Raised intra-abdominal pressure
- Congenital
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