Anorectal disorders

Differential Diagnosis

Anorectal Disorders

• Anal tags
• Hemorrhoids
  • Internal hemorrhoid
  • External hemorrhoid
• Cryptitis
• Anal fissure
• Anal fistula
• Anorectal abscess
• Proctitis
• Rectal prolapse
• Rectal foreign body
• Pruritus ani
• Pilonidal cyst
• Constipation
• Condyloma acuminata
• Anal cancer
• Colorectal tumor
• Pedunculated polyp
• Crohn Disease
• Syphilitic fissure
• GC/Chlamydia

Algorithmic Diagnostic Approach

Pain and Bleeding

1. External hemorrhoid
2. Prolapsed internal hemorrhoid
3. Anal Fissure
   1. Off midline = cancer, HIV, TB, Crohn's

Pain and No Bleeding

1. Swelling
   1. Abscess
      1. Perirectal
      2. Ischiorectal
      3. Intersphincteric
      4. Supralevator
   2. Pilonidal Cyst
   3. Anal Fistula
   4. Hidradenitis suppurativa
2. No swelling
   1. Proctalgia Fugax

Painless Bleeding

1. Cancer
2. Internal hemorrhoid

Painless Swelling

1. Itch: Condyloma acuminata (warts secondary to HPV)
2. No itch: Rectal prolapse

Itching

1. Discharge: Proctitis
2. No discharge: Pruritus Ani

See Also

• Diagnoses by Body Part (Main)

References

Authors

Ross Donaldson