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The Yale Journal of Biology and Medicine Dec 2014Increased anorectal human papillomavirus (HPV) infection is related to the recent trends in sexual behavior in both homosexual and heterosexual groups and prevalence of... (Review)
Review
Increased anorectal human papillomavirus (HPV) infection is related to the recent trends in sexual behavior in both homosexual and heterosexual groups and prevalence of infection with human immunodeficiency virus (HIV). Clinical presentation and natural history depend on the serotype involved. HPV 6 and 11 are found in the benign wart. Local control can be achieved with a wide selection of surgical and topical techniques. HPV 16, 18, and 31 are found in dysplastic lesions and have the potential to progress to invasive anal squamous cell carcinoma. Recognition and early management of dysplastic lesions is crucial to prevent the morbidity and mortality associated with anal cancer. While low-grade lesions can be closely observed, high-grade lesions should be eradicated. Different strategies can be used to eradicate the disease while preserving anorectal function. Studies on the efficacy of vaccination on anorectal HPV showed promising results in select population groups and led to the recent expansion of current vaccination recommendations.
Topics: Anus Diseases; Humans; Papillomaviridae; Papillomavirus Infections; Rectal Diseases; Vaccination
PubMed: 25506286
DOI: No ID Found -
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 -
Revista Chilena de Infectologia :... Apr 2013Globally, human papillomavirus (HPV) is the most frequent sexually transmitted infection (STI) and it affects men and women equally. In men, HPV has been mainly... (Review)
Review
Globally, human papillomavirus (HPV) is the most frequent sexually transmitted infection (STI) and it affects men and women equally. In men, HPV has been mainly associated with skin lesions like ano-genital warts and intraepithelial neoplasia of penis and anus in recent years. HPV prevalence in men varies extremely due to kind of sample and detection techniques. The most widely used samples to study HPV in men are: penile shaft, glans, prepuce, coronal sulcus, urine and semen, and its detection is usually performed with techniques like reverse line blot (RLB) and hybrid capture (HC). Given that the highest infection rates are in Africa and Latin America, the aim of this review is to describe the pathogenesis of HPV and its main detection techniques in men.
Topics: Anus Diseases; Genital Diseases, Male; Humans; Male; Papillomaviridae; Papillomavirus Infections; Sexually Transmitted Diseases, Viral
PubMed: 23677157
DOI: 10.4067/S0716-10182013000200009 -
World Journal of Gastroenterology Jul 2009Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary... (Review)
Review
Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. However, gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or non-surgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani.
Topics: Abscess; Anus Diseases; Fissure in Ano; Hemorrhoids; Humans; Pruritus Ani; Rectal Diseases; Rectal Fistula
PubMed: 19598294
DOI: 10.3748/wjg.15.3201 -
Surgery Today Mar 2023Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including...
PURPOSE
Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease.
METHODS
We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion.
RESULTS
After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03).
CONCLUSION
Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
Topics: Humans; Crohn Disease; Anus Diseases; Retrospective Studies; Surgical Stomas; Ileostomy; Postoperative Complications
PubMed: 35867163
DOI: 10.1007/s00595-022-02556-x -
Alimentary Pharmacology & Therapeutics May 2018Patient reported outcomes regarding perianal disease and faecal incontinence in the community-based inflammatory bowel disease population are poorly described.
BACKGROUND
Patient reported outcomes regarding perianal disease and faecal incontinence in the community-based inflammatory bowel disease population are poorly described.
AIMS
To determine the impacts of perianal disease and faecal incontinence on quality of life and employment in inflammatory bowel disease patients.
METHODS
For this cross-sectional study, a comprehensive survey was sent out to members of the Dutch National Crohn's and Colitis patient organisation. Validated questionnaires regarding faecal incontinence and active perianal disease were used to estimate its prevalence's. The effect on the quality of life (36-Item Short Form Survey) and on employment status (multivariate binary regression analysis) was assessed in this inflammatory bowel disease population.
RESULTS
A total number of 1092 returned questionnaires (58% responders) were used for analysis; 750 respondents (69%) were female; mean age was 47 years (IQR 35-59). In 621 patients (57%) Crohn's disease, in 422 (39%) ulcerative colitis and in 49 (4%) patients unclassifiable inflammatory bowel disease was self-reported. The 114 patients (10%) with a stoma were excluded for continence related analyses. Faecal incontinence was reported in 555 patients (57%), was comparable between the different inflammatory bowel disease diagnoses and affected all 36-Item Short Form Survey subscales adversely (incontinence vs continence: Physical functioning 75 vs 84, P < 0.0001; Limitations due to physical health 49 vs 63, P < 0.0001; Limitations due to emotional problems 49 vs 64, P < 0.0001; Energy/fatigue 47 vs 53, P < 0.0001; Emotional well-being 71 vs 74, P = 0.005; Social functioning 63 vs 73, P < 0.0001; Pain 66 vs 75, P < 0.0001; General health 41 vs 48, P < 0.0001). Active perianal disease was reported in 39% Crohn's disease, 16% ulcerative colitis (84% fissures) and 20% unclassifiable inflammatory bowel disease patients. Faecal incontinence was more common in patients with perianal disease (67% vs 53%, P = 0.003). When correcting for age, disease duration, inflammatory bowel disease-related surgery and faecal incontinence, active perianal disease was independently affecting employment (OR 0.67; 95% CI 0.50-0.91; P = 0.01).
CONCLUSIONS
Faecal incontinence and perianal disease are quality of life determining factors. Faecal incontinence needs more attention among clinicians, and development of new (drug) therapies needs to be focussed on perianal disease.
Topics: Adult; Animals; Anus Diseases; Cross-Sectional Studies; Employment; Fecal Incontinence; Female; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Netherlands; Perianal Glands; Prevalence; Quality of Life; Surveys and Questionnaires
PubMed: 29520808
DOI: 10.1111/apt.14599 -
Gastroenterology Clinics of North... Sep 2008Several organic and functional disorders of the urinary bladder, reproductive tract, anorectum, and the pelvic floor musculature cause pelvic pain. This article... (Review)
Review
Several organic and functional disorders of the urinary bladder, reproductive tract, anorectum, and the pelvic floor musculature cause pelvic pain. This article describes functional disorders in which chronic pelvic and anorectal pain cannot be explained by a structural or other specified pathology. Currently, these functional disorders are classified into urogynecologic conditions or cystitis and painful bladder syndrome, anorectal disorders, and the levator ani syndrome. Although nomenclature suggests that these conditions are distinct, there is considerable overlap of their symptoms and these disorders have much in common.
Topics: Anus Diseases; Chronic Disease; Cystitis, Interstitial; Female; Humans; Male; Pelvic Pain; Prostatitis; Rectal Diseases; Syndrome
PubMed: 18794003
DOI: 10.1016/j.gtc.2008.06.002 -
The Permanente Journal 2016Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect...
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
Topics: Abscess; Anal Canal; Anus Diseases; Defecation; Dietary Fiber; Fecal Incontinence; Fissure in Ano; Hemorrhoids; Humans; Physical Examination; Pruritus Ani; Rectal Diseases; Rectal Fistula; Rectum
PubMed: 27723447
DOI: 10.7812/TPP/15-222 -
Anales Del Sistema Sanitario de Navarra 2006Perianal affectation due to Crohn's disease includes a wide spectrum of lesions involving different management and prognosis. A thorough exploration of the patient,... (Review)
Review
Perianal affectation due to Crohn's disease includes a wide spectrum of lesions involving different management and prognosis. A thorough exploration of the patient, under anaesthetic if necessary, a rectoscope to evaluate the possible affectation of the rectum by the disease, and on occasions evaluation through endoanal echography or magnetic resonance, are the bases for a correct diagnostic and therapeutic focus. Pharmacology and surgery must be complementary in the treatment of perianal Crohn's disease and must pursue a double aim: to alleviate the symptomology of the patient and prevent possible complications. Except in situations of emergency due to perianal sepsis, medical treatment is the first step in managing perianal Crohn's disease, and on many occasions it will control the disease, making surgery unnecessary. When surgery is required, with the aim of a definitive treatment of the perianal lesion, the risk of developing complications, especially incontinence, must be contrasted.
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Anus Diseases; Crohn Disease; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Proctoscopy; Rectovaginal Fistula; Rectum
PubMed: 17224940
DOI: 10.4321/s1137-66272006000500006 -
Gastroenterology Clinics of North... Sep 2008Constipation caused by dyssynergic defecation is common and affects up to one half of patients with this disorder. It is possible to diagnose this problem through... (Review)
Review
Constipation caused by dyssynergic defecation is common and affects up to one half of patients with this disorder. It is possible to diagnose this problem through history, prospective stool diaries, and anorectal physiologic tests. Randomized controlled trials have now established that biofeedback therapy is not only efficacious but superior to other modalities and that the symptom improvement is caused by a change in underlying pathophysiology. Development of user friendly approaches to biofeedback therapy and use of home biofeedback programs will significantly enhance the adoption of this treatment by gastroenterologists and colorectal surgeons.
Topics: Anus Diseases; Ataxia; Biofeedback, Psychology; Constipation; Defecation; Humans; Rectal Diseases
PubMed: 18793997
DOI: 10.1016/j.gtc.2008.06.011