1. Common perianal conditions
Mr Rowan Collinson FRACS
Colorectal and General Surgeon

2. ‘Outlet-type’ PR bleeding
Haemorrhoids
Anal fissure
Anal fistula
Faecal incontinence
Pruritis ani

5. Haemorrhoids
Fissure
Proctitis

6. Haemorrhoids: Presentation
Rectal outlet bleeding
Lumps
Mucus discharge
Itch
Difficulty getting clean
Pain
‘constipation’
Straining
Incomplete evacuation
Blockage
Faecal incontinence
‘Rectal prolapse’

7. Risk factors increasing age pregnancy and childbirth Family history
Gravity
Straining…(really?)

9. Differential diagnosis
Anal tags
Fibroepithelial polyp
Sentinel pile/Fissure
Rectal mucosal prolapse
Rectal prolapse
Rectal tumour
Dermatitis

10. Be clear on what is the presenting complaint
Encourage conservative measures
Tailored approach to surgery

11. Conservative management
Cochrane review 2008
beneficial effect of fibre laxatives for improving symptoms
Especially bleeding
The results for other symptoms
prolapse, pain or itching
not as clear

12. Topical preparations

13. Little evidence of efficacy
In pregnancy avoid steroid preparations
Short term usage worth a trial

14. Rubber band ligation

15. Surgery Very dependent on symptoms
essential to establish the true presenting complaint.
Excisional haemorrhoidectomy versus Stapled haemorrhoidopexy

16. Anal fissure