Anorectal pain
Overview
Anorectal pain can be an incredibly uncomfortable symptom that may be caused by a wide range of conditions affecting the anus and rectum.
Aetiology
Causes of Anorectal Pain
- Thrombosed haemorrhoid
- Anal fissure
- Proctitis - IBD (Crohn's / ulcerative colitis), infectious proctitis, radiation proctitis
- Perianal abscess
- Prostatitis
- Proctalgia fugax
- Anal SCC
- Trauma
History of Presenting Complaint
Site
- Where the pain is - in the anus or rectum.
Onset
- Whether the pain began suddenly or gradually, and under what circumstances.
Character
The type of pain - sharp, dull or burning.- Sharp pain while passing stoolsSuggestive of anal fissure
- Aching pain after opening bowelsSuggestive of internal haemorrhoids
Radiation
- Whether the pain radiates anywhere else, such as the abdomen.
Associated Symptoms
Whether the pain is associated with any other symptoms.- Perianal massSuggestive of thombosed haemorrhoid, perianal abscess or anal SCC
- Blood stained stoolsSuggestive of proctitis
- Blood on toilet paperSuggestive of haemorrhoids or anal fissure
- Tenesmus - urge to defaecate despite passing stoolSuggestive of space-occupying lesion or proctitis
Timing
How long the pain has been going on for, and whether it is constant or comes and goes.- Intermittent spasms of severe painSuggestive of proctalgia fugax
- Worse at nightSuggestive of proctalgia fugax
Exacerbating Factors
Whether the patient has noticed anything that makes the pain worse.- Opening bowelsSuggestive of anal fissure
Alleviating Factors
- Whether there is anything that relieves the pain.
Severity
- How bad the pain is on a scale of 1-10, with 10 being the worse pain.
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