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FURTHER READING Chu CS, Pfister DG. Opportunities and challenges: human papillomavirus and cancer. J Natl Compr Canc Netw 2017; 726–9. Cross KL, Massey EJ, Fowler AL et al . The management of anal fissure: ACPGBI position statement. Colorectal Dis 2008; 10 3): ...

Fissurectomy Surgical excision of a fissure involves excising of the fibrotic edge, curettage of the base and excision of the sentinel tag and/ or anal papilla. Fissurectomy is an alternative to lateral internal sphincterotomy and is used if there are contr...

HAEMORRHOIDS Haemorrhoids are symptomatic enlargements of the internal haemorrhoidal venous plexus (Greek: haima = blood, rhoos flowing; synonym: piles, Latin: pila = a ball). Internal haemor rhoids characteristically lie in the 3, 7 and 11 o’clock positions (...

HIDRADENITIS SUPPURATIVA HA is a chronic suppurative condition of apocrine gland- bearing skin found in the axillae, submammary regions, nape of the neck, groin, mons pubis, inner thighs and sides of the scrotum, as well as the perineum and buttocks. It is ...

Hypertrophied anal papilla Anal papillae occur at the dentate line and are remnants of the ectodermal membrane that separated the hindgut from the proctodaeum. As these papillae are present in 60% of patients examined proctologically , they should be regarded...

INCONTINENCE Aetiology Continence is dependent upon the structural and functional integrity of both the neurological pathways and the gastro - - intestinal tract. The risk factors for incontinence are many ( Table 80.1 ). Patients complaining of the involunt...

Imperforate anus Imperforate anus (strictly , it should be anal ‘agenesis’ or ‘atre sia’) has historically been divided into two main groups – high and low – depending on the level of termination of the rectum in relation to the pelvic floor. Treatment and pr...

Injectable biomaterials Injectable biomaterials to add bulk to the anal canal and thereby augment faecal continence were first introduced by Shafik, who injected polytetrafluoroethylene paste into the anal submucosa. The ideal agent should be biocompatible, easy ...

Inspection The buttocks are gently parted to allow inspection of the anus and perineum: the presence of any skin lesions and whether they are confined to the perineum or evident elsewhere on general examination, e.g. psoriasis, lichen planus, or on genital ex...

Introduction No content extracted automatically.

Investigations Anorectal physiology studies provide objective assessment of the anorectal function. Manometry is a simple method for measuring internal (resting) and external (squeeze) anal sphincter tone. Endoanal ultrasonography (EAUS) provides a dynamic as...

Inflammatory bowel disease Stricture of the anorectum may complicate Crohn’s disease and, in this instance, the stricture is annular. These stenoses are characterised by transmural scarring and inflammation. Occasionally , an anal stricture may occur in ulcerat...

Lateral anal sphincterotomy In this operation, the internal sphincter is divided away from - the fissure itself – usually either in the right or the left lateral positions. The procedure can be carried out using an open or a closed method, under local, regiona...

Learning objectives To understand: The anatomy and physiology of the anus and anal • canal with special reference to clinical presentation, investigation and differential diagnosis

Lymphatic drainage Lymph from the upper half of the anal canal flows upwards to drain into the mesorectal lymph nodes and from there goes to the para-aortic nodes via the inferior mesenteric chain. Lymph Summary box 80.1 Anatomy and physiology of the anal can...

MALIGNANT TUMOURS Malignant lesions of the anus and anal canal Anal malignancy is rare and accounts for less than 2% of all large bowel cancers; however, the incidence is rising, with a direct association with HPV infection, AIN and immuno - - suppression. Th...

Management Most patients with incontinence can be managed conserva - tively with dietary advice, stool bulking or constipating agents, cleansing enemas, rectal irrigation, nurse-led bowel retraining, including specific biofeedback programmes, or anal plugs, whi...

NON-MALIGNANT STRICTURES: ANAL STENOSIS Anal stenosis is a rare but serious complication of anorectal surgery . Removal of excess anoderm and mucosa without adequate skin bridges during haemorrhoidectomy can lead to scarring and stricturing. Stenosis can als...