Last reviewed: 21 Aug 2021
Last updated: 11 Mar 2021

Summary

Definition

History and exam

Key diagnostic factors

  • rectal bleeding
  • perianal pain/discomfort

Other diagnostic factors

  • anal pruritus
  • tender palpable perianal lesion
  • anal mass

Risk factors

  • age between 45-65 years
  • constipation
  • pregnancy or space-occupying pelvic lesion
  • hepatic insufficiency
  • ascites

Diagnostic investigations

1st investigations to order

  • anoscopic exam
  • colonoscopy/flexible sigmoidoscopy
  • CBC
  • stool for occult heme

Treatment algorithm

Contributors

Authors

Mohamed A. Thaha, PhD, FRCS (Gen Surg), PG Cert Hlt Econ

Senior Lecturer and Consultant in Colorectal Surgery

National Bowel Research Centre (NBRC)

Blizard Institute

Barts and The London School of Medicine & Dentistry

Queen Mary University of London

Colorectal & Pelvic Floor Services

Royal London Hospital

Barts Health NHS Trust

London

UK

Disclosures

MAT declares that he has no competing interests.

Jayan D Jayasinghe, MD, MRCS

Senior Fellow in Colorectal Surgery

Colorectal Surgery & Pelvic Floor Services

Royal London Hospital

Barts Health NHS Trust

LondonĀ 

UK

Disclosures

JDJ declares that he has no competing interests.

Robert J.C. Steele, MD, FRCS

Professor of Surgery

Ninewells Hospital & Medical School

University of Dundee

Dundee

UK

Disclosures

RJCS declares that he has no competing interests.

Acknowledgements

Dr Mohamed A. Thaha and Professor Robert J.C. Steele would like to gratefully acknowledge Dr Kurt G. Davis, the previous contributor to this topic.

Disclosures

KGD declares that he has no competing interests.

Peer reviewers

George Reese, MB BS MRCS

Honorary Clinical Research Fellow

Division of Surgery

Oncology

Reproductive Biology and Anaesthetics

Imperial College

St Mary's Hospital

London

UK

Disclosures

GR declares that he has no competing interests.

Alexander von Roon, MRCS

Clinical Research Fellow

Department of Biosurgery and Surgical Technology

Imperial College

St Mary's Hospital

London

UK

Disclosures

AVR declares that he has no competing interests.

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