ANORECTAL COMPLAINTS are frequently encountered in many doctor's office. Mine is no exception. Most of these complaints can be managed in the office. Some do need further testing, and some do require other health care providers. The most common diagnosis is hemorrhoids or anal fissures. These can occur in both men and women. Other complaints are anorectal abscesses, rectal prolapse, anal masses/rectal carcinoma and even fistulas. Human Papilloma Virus ( HPV) is not only associated cervical carcinoma but has been associated with rectal carcinoma as well .These must be seen by a surgeon.
A detailed history needs to be taken. There might be some questions you might not be comfortable answering, but you should answer. First of all you should feel comfortable to ask your doctor anything. If you are a gay male, you might be more comfortable with a gay male physician. You should be able to discuss your sexual practices. The physician should be comfortable in asking a heterosexual individuals or couples about anal sexual activity It is very common among heterosexuals but no one discusses this entity. I always ask these questions. I always ask about dietary habits ( ex: I ask what the patient eats for breakfast, lunch and dinner) I ask about alcohol use. I ask about intake of fiber, salads, use of enemas, and intake of nuts/seeds.
I ask about travel history as anal problems, especially itching can be the first sign of a parasite. This is especially common in pin worms and whip worms. In order to fully exam the anal area the patient should be placed in prone jackknife or left lateral knee to chest position. This is called the Simm position. This is best way for any physician to examine the anal area.
Yes inspection, palpation and examination of the anal area is neither pleasant for you or the doctor but it should be done
For the simple hemorrhoid, there are anesthetic preparations, lidocaine derivatives and even calcium channel blockers as .2% ointment or diltizem 2% gel) I often utilize sitz baths, witch hazel and a homeopathic haemorrhoid cream
For any anal rectal problems please consult your physician .
Until tomorrow...