American Medical Association Family Medical Guide - American Medical Association [508]
Symptoms
The symptoms of rectal abscesses include intense pain in the rectal area (especially during a bowel movement), and bleeding and a discharge of pus-filled mucus from the rectum. A rectal abscess outside the body may be swollen and feel warm. You also may have a fever with chills.
Diagnosis and Treatment
To diagnose a rectal abscess, a doctor performs a digital rectal examination (see page 144) to feel for the abscess. He or she may also perform a procedure called anoscopy (see page 766) to examine the anus and rectum to look for an abscess. Ultrasound (see page 111) may also be used to help detect an abscess in the rectum. An abscess in the rectum is usually drained surgically. If the abscess is deep, general anesthesia may be necessary. The doctor will prescribe antibiotics to kill the bacteria.
Anal Fissures
An anal fissure is an elongated ulcer (sore) that extends upward into the anal canal from the anal opening. The cause is not known, but it may result from passing a large, hard stool. An anal fissure can also occur from injury to the delicate tissues of the anal canal during anal sex.
Symptoms
An anal fissure is easily irritated during a bowel movement. The fissure may also cause bleeding from the rectum. Sometimes the area is so painful that the anal sphincter tightens (spasms), causing more pain.
Diagnosis and Treatment
A doctor can diagnose an anal fissure by looking inside the anal canal. Most fissures heal on their own. For an anal fissure caused by constipation, a doctor will recommend eating high-fiber foods, drinking lots of water, exercising, and not delaying bowel movements or straining or sitting too long on the toilet. Sit on a doughnut-shaped pillow or rest in bed if you are having a painful attack. Your doctor may also recommend the self-help tips for anal itching to help heal irritated tissue and the self-help tips for hemorrhoids on the previous page because these tips also would help an anal fissure. If the fissure does not heal or if it recurs, your doctor may recommend surgery to widen the anal sphincter muscle and close the fissure.
Anal Fistulas
An anal fistula is a rare condition in which a tiny tubelike opening starts in the anal canal and ends in a small hole in the skin near the anal opening. The fistula is caused by the erosion of tissue from a spreading rectal abscess (see left). Anal fistulas are often a complication of Crohn’s disease (see page 764) or colon cancer (see page 775).
Symptoms and Diagnosis
A continuous discharge of watery pus through the fistula irritates the skin and causes pain and itching. The abscess itself may be painful. To diagnose an anal fistula, your doctor will order a barium enema (see page 767) or a CT scan (see page 112) with a contrast medium (dye). He or she will also perform a procedure called sigmoidoscopy (see page 144) to examine the anus and rectum.
Treatment
The treatment of an anal fistula depends on its cause. Fistulas caused by Crohn’s disease often heal when the inflammatory disorder is brought under control. To treat an anal fistula caused by a rectal abscess, a doctor will remove the fistula and drain the abscess.
Rectal Prolapse
Rectal prolapse is the displacement of the rectum from its normal position. In complete rectal prolapse, the membrane that lines the rectum and the muscle wall of the rectum protrude out of the anus. The disorder usually results from straining during bowel movements. Rectal prolapse is most common in older people because the tissues that support the perineum (the area between the genital organs and the anus) can weaken with age. In some women, the ligaments of the rectal area are