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Feature Article Gastroenterology
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Common benign perianal problems: getting to the bottom of the problem

Caroline Wright
Most patients presenting with anorectal symptoms will have benign anorectal pathology and can be successfully treated in the primary care setting; however, specialist referral should always be considered for patients with any suspicious symptoms or signs.
Key Points
  • Although most patients with anorectal symptoms presenting to their GPs have benign disease, the possibility of proximal colorectal pathology, including colorectal neoplasia, should always be considered and if suspected excluded by appropriate investigation.
  • Common benign anorectal disorders include internal and external haemorrhoids, anal fissures, anal abscesses and fistulas, rectal prolapse and pruritis ani.
  • The combination of presenting symptoms and signs, including pain, bleeding, presence of a lump or mass, discharge, and/or pruritis, is usually the key to diagnosis.
  • Most patients with symptomatic haemorrhoids, fissures and pruritis ani can be managed in the primary care setting.
  • In patients with disorders where the predisposing cause is defaecatory dysfunction (haemorrhoidal disorders, anal fissures or rectal prolapse), conservative management aimed at correcting this should always be discussed, whether or not surgical intervention is undertaken.
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