RESUMEN
PURPOSE: The without a time limitation. Most recent search was performed on 1st June 2022. RESULTS: Thorough history and physical examination are very important in view of multiple possible causes of anal pruritus. Most of the focus during examination is drawn on to the perianal region. A digital rectal examination and an anoscopy are essential. It is necessary aim of this narrative review is to overview the classification, diagnostics, possible treatment options and future perspective of anal pruritus. METHODS: The search was performed by two authors (AD and MJ) independently in the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Library, CENTRAL and the Allied and Complementary Medicine Databases (AMED). Search was restricted to English language only to avoid moisture and the use of soaps in the perianal region. Furthermore, the patient should avoid certain foods and increase the intake of fiber. If the symptoms do not resolve, topical steroids, capsaicin (0.006%) and tacrolimus (0.1%) ointments may be used. For intractable cases, intradermal methylene blue injection might give a long-lasting symptom relief. CONCLUSION: Anal pruritus is a long-term deteriorating quality of life issue. Most of the time it is a symptom with a difficult diagnosis. Thorough history and examination should be performed for the best possible treatment.
Asunto(s)
Prurito Anal , Calidad de Vida , Humanos , Prurito Anal/diagnóstico , Prurito Anal/etiología , Prurito Anal/terapia , Azul de Metileno , Capsaicina/uso terapéutico , Factores de TiempoRESUMEN
CASE SUMMARY: A 48-year-old healthy man presented to the office reporting a long-standing history of anal pruritus. He had tried various over-the-counter creams without much success. Besides an anal fissure in the past, which responded to nitroglycerin ointment, his medical history was unremarkable. On physical examination, he was found to have grade I hemorrhoids and mild fecal smearing on perianal skin. Recent colonoscopy and laboratory work ordered by the primary care provider were normal. He was counseled on common inciting agents and local irritants and was advised on hygiene, diet modification, and stool-bulking agents. The colorectal surgeon recommended that the patient keep a journal about his symptoms, foods, and household chemicals used. He was seen twice more over the course of 6 months to pinpoint the cause of his pruritus. A short-course trial of topical steroid, barrier cream, and topical tacrolimus was not helpful. A biopsy of perianal skin was performed and was unrevealing. Eventually, given the persistence of symptoms, it was decided that he would undergo methylene blue injection to address his pruritus (Fig. 1). The procedure consisted of several intradermal and subcutaneous injections of 10 mL of 1% methylene blue combined with 7.5 mL of 0.25% bupivacaine with adrenaline (1/100,000) and 7.5 mL 0.5% lidocaine. After the methylene blue injection, the severity of his symptoms improved, but pruritus still persisted. A methylene blue injection of the same concentration was repeated in 3 months with complete resolution of symptoms.
Asunto(s)
Fisura Anal , Hemorroides , Prurito Anal , Masculino , Humanos , Persona de Mediana Edad , Prurito Anal/etiología , Prurito Anal/terapia , Prurito Anal/diagnóstico , Azul de Metileno , Nitroglicerina , Hemorroides/complicacionesAsunto(s)
Prurito Anal , Humanos , Prurito Anal/diagnóstico , Prurito Anal/etiología , Prurito Anal/terapiaRESUMEN
La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)
Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Prurito Anal/diagnóstico , Prevalencia , Enterobiasis/diagnóstico , Enterobiasis/epidemiología , Medio Rural , Ecuador/epidemiología , Parasitosis IntestinalesAsunto(s)
Enterobiasis/diagnóstico , Prurito Anal/diagnóstico , Antinematodos/uso terapéutico , Niño , Diagnóstico Diferencial , Enterobiasis/tratamiento farmacológico , Enterobiasis/parasitología , Humanos , Masculino , Mebendazol/uso terapéutico , Prurito Anal/tratamiento farmacológico , Prurito Anal/parasitologíaRESUMEN
RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal.
ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal.
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/patología , Neoplasias del Ano/sangre , Transformación Celular Neoplásica , Sarcoma de Células Claras/diagnóstico , Melanocitos/metabolismo , Melanoma/diagnóstico , Melanoma/patología , Melanoma/sangre , Canal Anal/fisiopatología , Prurito Anal/diagnóstico , Metástasis de la NeoplasiaRESUMEN
Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from the perianal region, which are highly prevalent symptoms in the general population. Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes, and pruritus anii are the most common clinical disorders. Well-trained physicians, irrespective of their specialty, can treat most of these disorders and refer them to a specialist in proctology only when necessary. The aim of this review is to provide a practical guide to the management of benign anorectal disorders in terms of their initial management and the criteria for specialist referral.
Asunto(s)
Enfermedades del Recto/terapia , Fisura Anal/diagnóstico , Fisura Anal/terapia , Hemorroides/diagnóstico , Hemorroides/terapia , Humanos , Prurito Anal/diagnóstico , Prurito Anal/terapia , Enfermedades del Recto/diagnóstico , Fístula Rectal/diagnóstico , Fístula Rectal/terapiaRESUMEN
Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.
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Canal Anal/patología , Enfermedades del Recto/terapia , Recto/patología , Absceso/diagnóstico , Absceso/terapia , Enfermedades del Ano/diagnóstico , Enfermedades del Ano/terapia , Defecación , Fibras de la Dieta , Incontinencia Fecal/diagnóstico , Incontinencia Fecal/terapia , Fisura Anal/diagnóstico , Fisura Anal/terapia , Hemorroides/diagnóstico , Hemorroides/terapia , Humanos , Examen Físico , Prurito Anal/diagnóstico , Prurito Anal/terapia , Enfermedades del Recto/diagnóstico , Fístula Rectal/diagnóstico , Fístula Rectal/terapiaAsunto(s)
Alérgenos/efectos adversos , Enfermedades del Ano/etiología , Dermatitis Alérgica por Contacto/etiología , Prurito Anal/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades del Ano/diagnóstico , Niño , Preescolar , Estudios de Cohortes , Dermatitis Alérgica por Contacto/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Níquel/efectos adversos , Pruebas del Parche , Perfumes/efectos adversos , Conservadores Farmacéuticos/efectos adversos , Prurito Anal/diagnóstico , Resinas de Plantas/efectos adversos , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: Pruritus ani is defined as a dermatologic disease characterized by itching and/or burning in the perianal area. It occurs in 15% of the population. Men are affected more frequently than women, in the ratio 4:1. It is accompanied by an irresistible desire to scratch in the perianal area. Pruritus ani is divided into two subtypes: primary (idiopathic) and secondary. In idiopathic (primary) pruritus it is not possible to detect any other cause of itching. Secondary pruritus has an obvious causal origin.The aim of this paper is to offer a complex overview of possible causes, diagnostic procedures and treatment possibilities of this unpleasant and annoying disease. METHODS: We have researched available publications using PubMed and MEDLINE databases, focusing on articles on anal pruritus. At first the key word "Pruritus ani" was put in without any restrictions. Subsequently, we limited the selection by the time period of 5 years and 10 years; then we looked up articles in English, German and Czech languages, and finally review articles, clinical trials and others. RESULTS: 574 articles were found without entering any restrictions; 45 of them were review articles and 25 clinical trials. 437 articles were in the English language and 40 of them were review articles. 44 were in the German language and 1 of them was a review article. A total of 33 articles were found with a 5-year time limit. 6 of them were review articles and 4 were clinical trials. 66 articles from the last 10 years were found. 14 of them were review articles and 10 were clinical trials. In most of the other articles among the total number of articles found, pruritus ani was mentioned only marginally in articles focused on different topics. We have not found any summary articles on this topic in Czech publications. CONCLUSION: Pruritus ani is a common disease with a number of causes; therefore, effective treatment may be insufficient in the initial stages. The therapy is focused on the primary cause, if found. Broad differential diagnosis options need to be taken into consideration, and reevaluation of the therapy is a priority. When no obvious secondary cause is found, the empiric treatment is focused on an improvement of hygiene and change in the life style, removal of common irritators, and protection of perianal skin.
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Prurito Anal/etiología , Prurito Anal/terapia , Técnicas de Apoyo para la Decisión , Humanos , Anamnesis , Prurito Anal/diagnósticoRESUMEN
Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists due to delayed clinical presentation or prior treatment with over-the-counter medications. The distinct anatomical conditions of the (peri)anal region results in atypical clinical presentation of common dermatoses. Typical symptoms include pruritus, burning, bleeding and pain. Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis. In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.
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Enfermedades del Ano/diagnóstico , Enfermedades del Ano/etiología , Eccema/diagnóstico , Eccema/etiología , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/terapia , Diagnóstico Tardío , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Prurito Anal/diagnóstico , Prurito Anal/etiología , Prurito Anal/terapia , AutomedicaciónRESUMEN
Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better compared to arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnostic. We studied 30 cases of CVT diagnosed in the department of neurology of the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%) , consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behcet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes was observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.
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Neurodermatitis/diagnóstico , Prurito Anal/diagnóstico , Administración Tópica , Canal Anal/patología , Antiinflamatorios/administración & dosificación , Betametasona/administración & dosificación , Betametasona/análogos & derivados , Humanos , Masculino , Persona de Mediana Edad , Neurodermatitis/complicaciones , Neurodermatitis/tratamiento farmacológico , Prurito Anal/tratamiento farmacológico , Prurito Anal/etiologíaRESUMEN
Anorectal conditions are frequently encountered clinical entities but are often misunderstood and misdiagnosed. Although the most common anorectal disorders are not considered life threatening, they can negatively impact patients' activities of daily living and quality of life. Comprehensive anorectal examination, including the use of anoscopy, has become a "lost art," and graduate medical education programs should utilize more formal training in this area. This review discusses the comprehensive anorectal exam and the diagnosis and management of three common anorectal disorders: hemorrhoids, anal fissure, and pruritus ani.
Asunto(s)
Fisura Anal , Hemorroides , Examen Físico/métodos , Proctoscopía , Prurito Anal , Fisura Anal/diagnóstico , Fisura Anal/terapia , Hemorroides/diagnóstico , Hemorroides/terapia , Humanos , Prurito Anal/diagnóstico , Prurito Anal/terapiaRESUMEN
Anal pain is a common reason for consultation, whose etiology is varied and should not be limited to the hemorrhoidal disease. The purpose of this article is to conduct a review of the literature on anorectal pathologies most frequently encountered and make recommendations regarding their management.
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Dolor Agudo/etiología , Dolor Agudo/terapia , Canal Anal , Absceso/diagnóstico , Absceso/terapia , Algoritmos , Fisura Anal/diagnóstico , Fisura Anal/terapia , Hemorroides/diagnóstico , Hemorroides/terapia , Humanos , Prurito Anal/diagnóstico , Prurito Anal/terapiaRESUMEN
Pruritus ani is a common condition with multiple causes. Primary causes are thought to be fecal soiling or food irritants. Secondary causes include malignancy, infections including sexually transmitted diseases, benign anorectal diseases, systemic diseases, and inflammatory conditions. A broad differential diagnosis must be considered. A reassessment of the diagnosis is required if symptoms or findings are not responsive to therapy. The pathophysiology of itching, an overview of primary and secondary causes, and various treatment options are reviewed.
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Prurito Anal/diagnóstico , Neoplasias del Ano/complicaciones , Neoplasias del Ano/diagnóstico , Candidiasis/complicaciones , Candidiasis/diagnóstico , Carcinoma in Situ/complicaciones , Carcinoma in Situ/diagnóstico , Dermatitis Atópica/complicaciones , Dermatitis Atópica/diagnóstico , Dermatitis Seborreica/complicaciones , Dermatitis Seborreica/diagnóstico , Herpes Zóster/complicaciones , Herpes Zóster/diagnóstico , Humanos , Liquen Plano/complicaciones , Liquen Plano/diagnóstico , Liquen Escleroso y Atrófico/complicaciones , Liquen Escleroso y Atrófico/diagnóstico , Enfermedad de Paget Extramamaria/complicaciones , Enfermedad de Paget Extramamaria/diagnóstico , Prurito Anal/etiología , Prurito Anal/terapia , Psoriasis/complicaciones , Psoriasis/diagnóstico , Uremia/complicaciones , Uremia/diagnósticoRESUMEN
This is the second of two articles about the kinds of anorectal problem with which people can present at emergency departments. The first article concerns common symptoms and anorectal examination, while this one discusses the diagnosis and treatment of three common anorectal problems that can be managed by nurse practitioners: haemorrhoids, anal fissure and pruritus ani. Unexpected diagnoses might be found on examination and nurse practitioners should refer these patients to appropriate specialists.
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Fisura Anal , Hemorroides , Prurito Anal , Adulto , Anciano , Femenino , Fisura Anal/diagnóstico , Fisura Anal/enfermería , Fisura Anal/terapia , Hemorroides/diagnóstico , Hemorroides/enfermería , Hemorroides/terapia , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Practicantes , Prurito Anal/diagnóstico , Prurito Anal/enfermería , Prurito Anal/terapiaAsunto(s)
Adenocarcinoma/complicaciones , Canal Anal/patología , Neoplasias del Ano/complicaciones , Prurito Anal/diagnóstico , Adenocarcinoma/diagnóstico , Anciano , Neoplasias del Ano/diagnóstico , Biopsia , Colonoscopía , Diagnóstico Diferencial , Femenino , Humanos , Estadificación de Neoplasias , Prurito Anal/etiologíaRESUMEN
Introducción: El prurito anal es un síntoma de difícil tratamiento en ausencia de factores predisponentes. Cuando no se logra identificar una causa evidente es habitualmente llamado "prurito anal esencial, primario o idiopático" y en los casos de adjudicarse el síntoma a otra patología se lo refiere como prurito anal secundario. El prurito anal esencial es una patología que representa un desafío para el médico tratante debido al poco consenso sobre el tratamiento de la misma. Objetivo: Realizar una revisión bibliográfica sobre prurito anal primario o idiopático. Presentar un algoritmo de diagnóstico y de tratamiento de pacientes que consultan por esta patología. Efectuar una evaluación inicial de los resultados obtenidos a corto plazo. Lugar de aplicación: Centro Privado de Cirugía y Coloproctología de la Ciudad de Buenos Aires. Diseño: Estudio retrospectivo, descriptivo, observacional y longitudinal. Pacientes y métodos: Se presentan 24 pacientes con diagnóstico de prurito anal esencial que fueron sometidos a tratamiento escalonado del mismo. Resultados: Se obtuvo respuesta favorable completa (ausencia del síntoma prurito por un período mayor a 15 días y con ausencia de lesiones por rascado) en 22 de los 24 pacientes (91,66%), en 2 pacientes (8,33%) se obtuvo respuesta casi completa (mejoría que se traduce en prurito leve sin lesiones cutáneas). No hubo recurrencias ni empeoramiento de los síntomas en ningún paciente. Conclusiones: La mayoría de los casos de prurito anal se deben a una causa coloproctológica o dermatológica, siendo menos frecuentes los casos en los que no se observa una causa responsable. Esta situación tiene relativa frecuencia y representa un desafío tanto para el médico tratante como para el paciente.
Introduction: Pruritus ani is a symptom of difficult treatment in the absence of predisposing factors. When not able to identify an obvious cause is usually called "essential, primary or idiopathic pruritus ani" and in case of winning the symptom to another condition is referred secondary anal itching. The idiopathic anal pruritus is a condition that poses a challenge to the treating physician due to little consensus on the treatment of it. Objetive: To review the literature on primary or idiopathic pruritus ani. To present an algorithm for diagnosis and treatment of patients who consult for this condition. Make an initial assessment of the results obtained in the short term follow-up. Application site: Private Center of Surgery and Coloproctology of the city of Buenos Aires. Design: Retrospective, descriptive, observational and longitudinal study. Patients and Methods: We present 24 patients with idiopathic anal pruritus underwent treatment in stages. Results: Favorable response was obtainded (absence of pruritlls for a period exceeding 15 days and with no scratching injuries) in 22 of 24 patients (91,66%), in 2 patients (8,33%) was obtained almost response almost complete (resulting in improvement mild itching without skin lesions). There was no recurrence or worsening of symptoms in any patient. Conclusions: Most cases of anal pruritus due to one cause dermatological or proctology, being less frequent cases in which there is observed a cause responsible. This situation is relatively common and poses a challengue for both physician and patient.
Asunto(s)
Humanos , Masculino , Adulto , Femenino , Persona de Mediana Edad , Enfermedades Inflamatorias del Intestino/complicaciones , Enfermedades de la Piel/complicaciones , Prurito Anal/diagnóstico , Prurito Anal/dietoterapia , Prurito Anal/etiología , Prurito Anal/terapia , Administración Tópica , Estudios de Seguimiento , Hidrocortisona/administración & dosificación , Resultado del TratamientoRESUMEN
The prevalence of benign anorectal conditions in the primary care setting is high, although evidence of effective therapy is often lacking. In addition to recognizing common benign anorectal disorders, physicians must maintain a high index of suspicion for inflammatory and malignant disorders. Patients with red flags such as increased age, family history, persistent anorectal bleeding despite treatment, weight loss, or iron deficiency anemia should undergo colonoscopy. Pruritus ani, or perianal itching, is managed by treating the underlying cause, ensuring proper hygiene, and providing symptomatic relief with oral antihistamines, topical steroids, or topical capsaicin. Effective treatments for anal fissures include onabotulinumtoxinA, topical nitroglycerin, and topical calcium channel blockers. Symptomatic external hemorrhoids are managed with dietary modifications, topical steroids, and analgesics. Thrombosed hemorrhoids are best treated with hemorrhoidectomy if symptoms are present for less than 72 hours. Grades I through III internal hemorrhoids can be managed with rubber band ligation. For the treatment of grade III internal hemorrhoids, surgical hemorrhoidectomy has higher remission rates but increased pain and complication rates compared with rubber band ligation. Anorectal condylomas, or anogenital warts, are treated based on size and location, with office treatment consisting of topical trichloroacetic acid or podophyllin, cryotherapy, or laser treatment. Simple anorectal fistulas can be treated conservatively with sitz baths and analgesics, whereas complex or nonhealing fistulas may require surgery. Fecal impaction may be treated with polyethylene glycol, enemas, or manual disimpaction. Fecal incontinence is generally treated with loperamide and biofeedback. Surgical intervention is reserved for anal sphincter injury.
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Enfermedades del Recto/diagnóstico , Enfermedades del Recto/terapia , Enfermedades del Ano/diagnóstico , Enfermedades del Ano/terapia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamiento farmacológico , Fisura Anal/diagnóstico , Fisura Anal/tratamiento farmacológico , Hemorroides/diagnóstico , Hemorroides/terapia , Humanos , Prurito Anal/diagnóstico , Prurito Anal/tratamiento farmacológicoRESUMEN
BACKGROUND: Anal pruritus affects up to 5% of the population. It is often persistent and the constant urge to scratch the area can cause great distress. Although usually caused by a combination of irritants, particularly faecal soiling and dietary factors, it can be a symptom of serious dermatosis, skin or generalised malignancy or systemic illness. OBJECTIVE: This article discusses the assessment and management of pruritus ani. DISCUSSION: It is important not to trivialise the symptom of anal pruritus and to enquire about patient concerns regarding diagnosis. Once serious pathology has been excluded, management involves education about the condition; elimination of irritants contributing to the itch-scratch cycle including faecal soiling, dietary factors, soaps and other causes of contact dermatitis; and use of emollients and topical corticosteroid ointments. Compounded 0.006% capsaicin appears to be a safe and valid option for pruritus not responding despite adherence to these conservative measures.