Squamous cell carcinoma of the anus or the anal canal may develop from HPV. Radiotherapy with chemotherapy can cure this malignancy. In case of failure, salvage abdomino-perineal resection is required.
Coccygodynia is defined as a pain when the coccyx is mobilized by digital exmination per rectum. The pain goes also along the sacro-coccygeal junction and at the insertion site of the levator ani. Trauma or repeated microtrauma (horse riding), obstetrical conditions or rhematic lesions are common causes of coccygodynia.Coccygectomy may be advised in cases of failure of medical treatment.
Anal warts arise after an infection of human papilloma virus (HPV). This is a sexually transmitted disease. For perianal condyloma, podophilline cream may be used while for warts inside the anal canal, surgical resection is advised.
An anal fissure is a tear in the skin lining the anal canal that becomes later a type of ulcer. Defecation is painful because of the anal spasm. For acute anal fissure, topic nitroglycerine may help to heal the ulcer. Lateral sphincterotomy is a more definitive therapy.
An anal fistula is a track between the perianal skin and the internal side of the anal canal. A perianal abscess ma develop from a fistula. More frequent fistulae are inter-sphincteric or trans-sphincteric. Anal ultrasound and pelvic magnetic resonance imaging (MRI) may help to classify the fistulous track with respect to the anal sphincter. Once the abcess is drained with a Seton technique, excision of the fistula and rectal adavancement track needs to be performed several weeks later.
Haemorrhoids (or piles) are swollen blood vessels in the anal canal. They seem to occur in some families, and are also frequent during or after pregnancy. High fiber diet and good liquid intake are recommended. Internal haemorrhoids may bleed or prolapse outside the anus. In this case, surgery may be advised: endorectal haemorrhoidopexy or Longo technique is the procedure of choice. Thrombosis (clot) of external haemorrhoids is painful. If the size of the thrombosis is large, incision of the haemorrhoid or surgical resection is required (Milligan Morgan procedure).
A pilonidal sinus is an inflamed tract (or more than one) which leads to a cavity under the skin between the buttocks. The inwards hair growing is thought to be the start of this condition. Lord procedure or removal the sinus tracts may cure the patient. In more complex cases, sinus excision and rotating Limberg flap is advised.
Rectal flap advancement after trans-sphincteric fistula excision
Excision of a pilonidal sinus
Excision of a pilonidal sinus with Limberg flap