Review

Authors: Charles H Knowles, Richard C Cohen

Chronic anal pain is difficult to diagnose and treat, especially with no obvious anorectal cause apparent on clinical examination. This review identifies 3 main diagnostic categories for chronic anal pain: local causes, functional anorectal pain, and neuropathic pain syndromes. Conditions covered within these categories include proctalgia fugax, levator ani syndrome, pudendal neuralgia, and coccygodynia. The signs, symptoms, relevant diagnostic tests, and main treatments for each condition are reviewed.

Topics: Anus Diseases; Chronic Pain; Humans; Neuralgia; Pain; Pelvic Pain

PubMed: 35649568
DOI: 10.3949/ccjm.89a.21102

Review

Authors: Kapil Sahnan, Samuel O Adegbola, Phillip J Tozer...

Topics: Abscess; Adult; Anal Canal; Anus Diseases; Bacterial Infections; Female; Humans; Incidence; Male; Rectal Fistula; Risk Factors; United Kingdom

PubMed: 28223268
DOI: 10.1136/bmj.j475

Review

Authors: S Mark Scott, Emma V Carrington

PURPOSE OF REVIEW

Objective measurement of anorectal sensorimotor function is a requisite component in the clinical evaluation of patients with intractable symptoms of anorectal dysfunction. Regrettably, the utility of the most established and widely employed investigations for such measurement (anorectal manometry (ARM), rectal sensory testing and the balloon expulsion test) has been limited by wide variations in clinical practice.

RECENT FINDINGS

This article summarizes the recently published International Anorectal Physiology Working Group (IAPWG) consensus and London Classification of anorectal disorders, together with relevant allied literature, to provide guidance on the indications for, equipment, protocol, measurement definitions and results interpretation for ARM, rectal sensory testing and the balloon expulsion test. The London Classification is a standardized method and nomenclature for description of alterations in anorectal motor and sensory function using office-based investigations, adoption of which should bring much needed harmonization of practice.

Topics: Anal Canal; Anus Diseases; Humans; Manometry; Rectal Diseases; Terminology as Topic

PubMed: 32935278
DOI: 10.1007/s11894-020-00793-z

Review

Authors: Marat Khaikin, Yehuda Chowers, Oded Zmora...

Perianal Crohn's disease refers to the involvement of the anal region in this chronic inflammatory bowel disease. It most commonly presents with the formation of perianal abscesses and fistulas, although other forms of presentations such as fissures and skin tags may also be present. Perianal activity often parallels abdominal disease activity, but may occasionally be the primary site of active disease, and significantly compromises the quality of life in affected patients. The primary treatment of patients with perianal Crohn's disease combines medical and surgical management with the aim of improving quality of life and alleviating suffering. A multidisciplinary approach involving the patient, surgeon, gastroenterologist, radiologist, pathologist, nutritionist, and other specialists makes the successful treatment of PCD possible. This paper reviews the management of patients with perianal Crohn's disease, focusing on contemporary medical and surgical treatments such as infliximab, endorectal advancement flap, instillation of fibrin glue, and the potential use of extracellular matrix plugs.

Topics: Anus Diseases; Combined Modality Therapy; Crohn Disease; Diagnostic Imaging; Humans

PubMed: 17402327
DOI: No ID Found

Review

Authors: Adil E Bharucha, Tae Hee Lee

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

Authors: XiaoYu Zeng, HanYu Wang, Ting Wu...

Although observational clinical studies have established an association between Intestinal Diseases (IDS) and Anal Diseases (ADS), the causal relationship is still not fully understood due to the limitations of observational studies. Genome-wide association study (GWAS) statistical data for IDS and ADS were obtained from publicly available databases. To assess the causal effects of IDS on ADS, we conducted Mendelian randomization analysis. The inverse variance weighted method indicated that Inflammatory bowel disease (IBD) had a significant causal relationship with three kinds of ADS: Anorectal abscess (ARB), Haemorrhoidal disease (HEM), and Fissure and fistula of anal and rectal regions (FISSANAL). Crohn's disease (CD) and Ulcerative colitis (UC) also showed significant causal effects with three ADS: ARB, HEM, and FISSANAL. Furthermore, a potential link between CD and BNA(Benign neoplasm of anus and anal canal), Irritable bowel syndrome (IBS) and HEM, Colorectal cancer (CRC) and BNA, and Celiac disease and MNA (Malignant neoplasm of anus and anal canal) was observed. This comprehensive MR analysis highlight the significant and increased risk of common Anal Diseases (ARB, FISSANAL, and HEM) in patients with IBD, CD, and UC. Additionally, potential positive causal associations emerged between IBS and HEM, CRC and BNA, as well as between celiac disease and MNA.

Topics: Intestinal Diseases; Anus Diseases; Mendelian Randomization Analysis; Humans; Genetic Association Studies; Risk Factors; Genetic Predisposition to Disease; Bayes Theorem

PubMed: 39414900
DOI: 10.1038/s41598-024-75082-0

Review

Authors: J Bassas-Vila, Y González Lama

The first description of perianal fistulas and complications in Crohn disease was made 75 years ago by Penner and Crohn. Published studies have subsequently confirmed that perianal fistulas are the most common manifestations of fistulising Crohn disease. Hidradenitis suppurativa was described in 1854 by a French surgeon, Aristide Verneuil. It is a chronic, inflammatory, recurrent and debilitating disease of the pilosebaceous follicle, that usually manifests after puberty with deep, painful and inflamed lesions in the areas of the body with apocrine glands, usually the axillary, inguinal and anogenital regions. The differential diagnosis between hidradenitis suppurativa and Crohn disease can be challenging, especially when the disease is primarily perianal. When they occur simultaneously, hidradenitis suppurativa and Crohn disease show severe phenotypes and patients can respond to anti-tumour necrosis factor therapy, although adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease. In addition, there is sometimes a need for different complementary surgical procedures.

Topics: Adalimumab; Anus Diseases; Biological Factors; Carcinoma, Squamous Cell; Colonoscopy; Crohn Disease; Cutaneous Fistula; Diagnosis, Differential; Hidradenitis Suppurativa; Humans; Intestinal Fistula; Organ Specificity; Phenotype; Skin Neoplasms; Tumor Necrosis Factor-alpha

PubMed: 28081767
DOI: 10.1016/S0001-7310(17)30006-6

Review

Authors: Tatiana Pacheco, Sara Monteiro, Luísa Barros...

The perianal disease affects up to one-third of individuals with Crohn's disease (CD), causing disabling symptoms and significant impairment in quality of life, particularly for those with perianal fistulising CD (PFCD). The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing. Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents, endoscopic procedures and surgical techniques that show promising results. Among these, mesenchymal stem cells injection is a particularly hopeful therapy. In addition to the burden of fistulas, individuals with perianal CD may face an increased risk of developing anal cancer. This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes. Currently, there is no established formal anal screening programme. In this review, we provide an overview of the current state of the art in managing PFCD, including novel medical, endoscopic and surgical approaches. The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD, intending to propose a risk-based surveillance algorithm. The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.

Topics: Humans; Anus Neoplasms; Rectal Fistula; Crohn Disease; Early Detection of Cancer; Quality of Life; Anal Canal; Risk Factors

PubMed: 39091713
DOI: 10.3748/wjg.v30.i28.3373

Review

Authors: J Berth-Jones, R A Graham-Brown, D A Burns...

Topics: Adolescent; Anus Diseases; Child; Child Abuse, Sexual; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Male; Prognosis; Skin Diseases; Vulvar Diseases

PubMed: 2675775
DOI: 10.1136/adc.64.8.1204

Review

Authors: Daniel Mark Skovgaards, Helene Perregaard, Kikke Bartholin Hagen...

Anal abscesses are well-known conditions worldwide. The golden standard of acute treatment is incision and drainage. Knowledge of the anatomy of the anal area and the abscess involvement of perianal spaces is crucial in order to perform safe and correct surgical treatment as summarised in this review. Pre- and perioperative imaging with magnetic resonance imaging, endoanal ultrasonography or CT facilitates correct incision and drainage, while antibiotics as conservative approach have no place in the treatment of abscesses. One third of the patients have an underlying fistula, and if suspected referral to a fistula centre is warranted.

Topics: Abscess; Anal Canal; Anus Diseases; Drainage; Humans; Rectal Fistula

PubMed: 33317691
DOI: No ID Found