| Symptom assessment | Perianal pruritus mainly present during the night |
-
Consider enterobiosis (eggs are not visible with the naked eye and stool samples are only positive in 5–15%). -
Send a sample of transparent adhesive tape (eg, Scotch Tape) applied on the anal area for microscopic analysis.
|
| Due to excess pancreatic enzyme replacement | Alter dose. |
| Visual assessment | Changes due to radiotherapy |
-
If soiling see guidance for faecal incontinence (page 8). -
If loose stool/diarrhoea present investigate for possible causes (page 7). -
Perianal skin care (pages 19–20). -
Topical barrier agent. -
Topical corticosteroids (Trimovate (GlaxoSmithKline UK, Uxbridge, UK)). -
Consider referral to dermatologist.
|
| No changes due to radiotherapy |
-
Perianal skin care (pages 19–20). -
Consider referral to dermatologist.
|
| Protoscopy/flexible sigmoidoscopy | Haemorrhoids |
-
Stool bulking/softening agent ± short-term topical local anaesthetic. -
Consider referral for surgical review for grade 3 or 4 haemorrhoids.
|
| Anal fissure |
-
Topical healing agent, eg, GTN or diltiazem gel (for 8 weeks). -
Stool bulking/softening agent ± short-term topical local anaesthetic. -
If fissure not healed after 2 months, refer for surgical opinion.
|
| Anorectal fistula |
-
Pelvic MRI. -
Refer to a colorectal surgeon.
|
| Anorectal abscess | This is an emergency
Discuss immediately with a GI surgeon regarding treatment with antibiotics and/or drainage. |
| Anorectal ulcer | Check patient is not on nicorandil. |
| If radiation related | Do not biopsy
-
Sucralfate enemas. -
Consider stool bulking/softening agent. -
Antibiotics. -
Consider hyperbaric oxygen therapy. -
Refer to a specialist centre.
|
| Mucosal prolapse/solitary rectal ulcer | Refer to colorectal surgeon/gastroenterologist. |
| Neoplastic ulcer | Refer urgently to appropriate oncology team requesting an appointment within 2 weeks. |