Escolar Documentos
Profissional Documentos
Cultura Documentos
Problems
Anatomy
Dentate line divides
the rectal mucosa,
which is generally
insensitive and is lined
with columnar mucosa,
from the anoderm,
which is highly
sensitive (because of
somatic innervation)
and lined with modified
squamous mucosa.
Benign Rectal, Anal, and
Perineal Problems
Anatomy (continue)
The anal canal is surrounded by two muscles
- Internal sphincter innervated by autonomic
nervous system, maintaining resting anal
tone and under involuntary control
- External sphincter innervated by somatic
nerve fibers, generates the voluntary anal
squeeze and plays the key role in
maintaining anal continence
Benign Rectal, Anal, and Perineal
Problems
Anatomy (continue)
The areas
surrounding the
anorectum is
divided into four
spaces
- Peri-anal
- Ischioanal
- Supralevator
- Intersphincteric
(intermuscular)
Hemorrhoids
Broadly classified as
- Internal proximal
to dentate
- External distal to
dentate, redundant
folds of peri-anal
skin, usually
asymptomatic
unless thromboses
Hemorrhoids
Hemorrhoids
Procedures
Hemorrhoidectomy
Stapled Hemorrhoidectomy
Hemorrhoids
External Hemorrhoids
Asymptomatic except when secondary thrombosed
Thrombosis may result from defecatory straining or
extreme physical activity or may be random event
Patient presents with constant anal pain of acute onset
Physical examination identifies external thrombosis as
purple mass at anal verge
Management
- Depends on patients symptoms
- In the first 24 72 hours after onset, pain increase
and excision is warranted
- After 72 hours, pain generally diminishes
Hemorrhoids
External Hemorrhoids
If operative treatment is
chosen, entire thrombosed
hemorrhoid has to be
excised
Incision and drainage of
clot shouldnt be done as
this can lead to re-
thrombosis and
exacerbation of symptoms