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The British Journal of Surgery Sep 2022Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Perianal abscess is common. Traditionally, postoperative perianal abscess cavities are managed with internal wound packing, a practice not supported by evidence. The aim of this randomized clinical trial (RCT) was to assess if non-packing is less painful and if it is associated with adverse outcomes.
METHODS
The Postoperative Packing of Perianal Abscess Cavities (PPAC2) trial was a multicentre, RCT (two-group parallel design) of adult participants admitted to an NHS hospital for incision and drainage of a primary perianal abscess. Participants were randomized 1:1 (via an online system) to receive continued postoperative wound packing or non-packing. Blinded data were collected via symptom diaries, telephone, and clinics over 6 months. The objective was to determine whether non-packing of perianal abscess cavities is less painful than packing, without an increase in perianal fistula or abscess recurrence. The primary outcome was pain (mean maximum pain score on a 100-point visual analogue scale).
RESULTS
Between February 2018 and March 2020, 433 participants (mean age 42 years) were randomized across 50 sites. Two hundred and thirteen participants allocated to packing reported higher pain scores than 220 allocated to non-packing (38.2 versus 28.2, mean difference 9.9; P < 0.0001). The occurrence of fistula-in-ano was low in both groups: 32/213 (15 per cent) in the packing group and 24/220 (11 per cent) in the non-packing group (OR 0.69, 95 per cent c.i. 0.39 to 1.22; P = 0.20). The proportion of patients with abscess recurrence was also low: 13/223 (6 per cent) in the non-packing group and 7/213 (3 per cent) in the packing group (OR 1.85, 95 per cent c.i. 0.72 to 4.73; P = 0.20).
CONCLUSION
Avoiding abscess cavity packing is less painful without a negative morbidity risk.
REGISTRATION NUMBER
ISRCTN93273484 (https://www.isrctn.com/ISRCTN93273484).
REGISTRATION NUMBER
NCT03315169 (http://clinicaltrials.gov).
Topics: Abscess; Adult; Anus Diseases; Bandages; Drainage; Humans; Pain; Rectal Fistula; Treatment Outcome
PubMed: 35929816
DOI: 10.1093/bjs/znac225 -
Annals of African Medicine 2019An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which...
BACKGROUND
An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life.
AIMS
To study the predilection sites, presentation and treatment of haemorrhoidal disease.
PATIENTS AND METHOD
A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY.
RESULTS
One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively.
CONCLUSION
The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal; Cohort Studies; Endoscopy; Female; Hemorrhoids; Humans; Ligation; Male; Middle Aged; Nigeria; Pain, Postoperative; Rectum; Sclerotherapy; Severity of Illness Index; Sex Distribution; Treatment Outcome; Young Adult
PubMed: 30729927
DOI: 10.4103/aam.aam_4_18 -
Mayo Clinic Proceedings Oct 2016Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this... (Review)
Review
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
Topics: Algorithms; Anal Canal; Anus Diseases; Cystitis, Interstitial; Female; Humans; Male; Muscular Diseases; Pain; Pelvic Pain; Prostatitis
PubMed: 27712641
DOI: 10.1016/j.mayocp.2016.08.011 -
BMJ Clinical Evidence Nov 2014Anal fissures are a common cause of anal pain during, and for 1 to 2 hours after, defecation. The cause is not fully understood, but low intake of dietary fibre may be a... (Review)
Review
INTRODUCTION
Anal fissures are a common cause of anal pain during, and for 1 to 2 hours after, defecation. The cause is not fully understood, but low intake of dietary fibre may be a risk factor.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of surgical treatments for chronic anal fissure? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found nine studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: anal advancement flap, anal stretch/dilation, and internal anal sphincterotomy.
Topics: Anal Canal; Fissure in Ano; Humans; Risk Factors; United States
PubMed: 25391392
DOI: No ID Found -
British Medical Journal Jun 1973In 33 patients with an intersphincteric abscess continuous anal pain was the commonest symptom and a lump in the wall of the anal canal the commonest sign.The importance...
In 33 patients with an intersphincteric abscess continuous anal pain was the commonest symptom and a lump in the wall of the anal canal the commonest sign.The importance of this condition as a cause of persistent undiagnosed anal pain is stressed.
Topics: Abscess; Adult; Age Factors; Aged; Anus Diseases; Female; Fissure in Ano; Humans; Male; Middle Aged; Pain; Sex Factors
PubMed: 4714472
DOI: 10.1136/bmj.2.5865.537 -
Journal of the Experimental Analysis of... Nov 2020Impatience can be formalized as a delay discount rate, describing how the subjective value of reward decreases as it is delayed. By analogy, selfishness can be...
Impatience can be formalized as a delay discount rate, describing how the subjective value of reward decreases as it is delayed. By analogy, selfishness can be formalized as a social discount rate, representing how the subjective value of rewarding another person decreases with increasing social distance. Delay and social discount rates for reward are correlated across individuals. However no previous work has examined whether this relationship also holds for aversive outcomes. Neither has previous work described a functional form for social discounting of pain in humans. This is a pertinent question, since preferences over aversive outcomes formally diverge from those for reward. We addressed this issue in an experiment in which healthy adult participants (N = 67) chose the timing and intensity of hypothetical pain for themselves and others. In keeping with previous studies, participants showed a strong preference for immediate over delayed pain. Participants showed greater concern for pain in close others than for their own pain, though this hyperaltruism was steeply discounted with increasing social distance. Impatience for pain and social discounting of pain were weakly correlated across individuals. Our results extend a link between impatience and selfishness to the aversive domain.
Topics: Adult; Altruism; Choice Behavior; Delay Discounting; Female; Humans; Male; Models, Psychological; Pain; Reward; Social Isolation; Social Perception
PubMed: 33026113
DOI: 10.1002/jeab.631 -
Evidence-based Complementary and... 2022Anal pain and urinary retention are the two most outstanding complications of the procedure for prolapse and hemorrhoids (PPH) surgery. This study intended to assess the...
Anal pain and urinary retention are the two most outstanding complications of the procedure for prolapse and hemorrhoids (PPH) surgery. This study intended to assess the clinical effect and mechanism of Prostant on urinary retention and anal pain after the PPH. Here, 30 patients received PPH surgery. The role and mechanism of Prostant in patients and mice with urinary retention and anal pain were evaluated. ANOVA tests were executed and differences between groups were regarded as statistically significant when < 0.05. Prostant effectively improved the urination status, lower abdomen symptoms, time to urinate and score of VAS, and the reduction of TNF- and IL-6. Similarly, Prostant can ameliorate the outcome of urodynamics in urinary retention mice. Mechanically, Prostant reversed the urinary retention-elevated the serum level of hs-CRP and TNF-, reduction of IL-2, imbalance of Treg/Th17, and level of JAK2 and phosphorylated STAT3. Besides, Prostant ameliorated the pain as shown by the reduction of writhing response, and the elevation of threshold of pain and degree of swelling. Moreover, Prostant antagonized the pain-induced dysregulation of Treg/Th17. Therefore, Prostant can treat patients and mice with anal pain and urinary retention by modulating the balance of Th17/Treg to regulate the secretion and production of inflammatory factors. We hope our results can establish a scientific treatment approach for solving anal pain and urinary retention after PPH surgery of mixed hemorrhoids.
PubMed: 36110189
DOI: 10.1155/2022/2570169 -
Clinics in Colon and Rectal Surgery May 2007Anal fissure is a common problem, vexing to both patients and physicians. The historical mainstay of therapy has been some method of partial division of the internal...
Anal fissure is a common problem, vexing to both patients and physicians. The historical mainstay of therapy has been some method of partial division of the internal anal sphincter with the serious potential complication of fecal incontinence. Nonsurgical treatment methods were therefore pursued, producing healing rates less than that seen after surgical therapy but none of the morbidity of surgery. This article summarizes accepted methods of modern medical and surgical therapy for anal fissure and offers a rationale for treatment type selection.
PubMed: 20011388
DOI: 10.1055/s-2007-977492 -
Missouri Medicine 2020Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent... (Review)
Review
Anorectal conditions are one of the most common problems evaluated by primary care physicians. Most patients present with rectal pain, rectal bleeding, or purulent drainage per rectum. Colorectal conditions have overlapping symptoms. Thorough history and careful anorectal examination can differentiate common anorectal conditions like hemorrhoids, anorectal abscesses, anal fistula, anal fissure, and anal condyloma. Most of these conditions can be diagnosed and treated without imaging.
Topics: Anus Diseases; Colorectal Surgery; Diagnosis, Differential; Fissure in Ano; Hemorrhoids; Humans; Primary Health Care
PubMed: 32308242
DOI: No ID Found