Common Anal Conditions · Version 2.0

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Dr. Tamer Rushdy Elalfy · 3 min read

📜 OPEN-ACCESS LICENCE AND COPYRIGHT NOTICE

Title: Common Anal Conditions: A Practical, Algorithmic Handbook for Non-Surgeons (Emergency Physicians, Family Medicine/GPs, Medical Specialists, and ER and Ward Nurses).

Author: Dr. Tamer Rushdy Elalfy, Consultant General Surgeon and Head of General Surgery and Operating Room Department, Mohammad Dossary Hospital, Al Khobar, Kingdom of Saudi Arabia · Zagazig University, Zagazig, Egypt · Founder, AlfiSurgery.com · ORCID 0000-0003-3769-2445 · Contact: Alfitamir@yahoo.com

Edition: Version 2.0 — Second Open-Access Clinical Edition (2026). Supersedes Version 1.0 (First Open-Access Clinical Edition, 23 October 2026).

Copyright: © 2026 Dr. Tamer Rushdy Elalfy. Some rights reserved.

Licence: This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Licence (CC BY-NC-SA 4.0). You may share (copy and redistribute in any medium or format) and adapt (remix, transform, and build upon) the material for any non-commercial clinical, hospital, or educational purpose, provided you credit Dr. Tamer Rushdy Elalfy (alfisurgery.com), link to the licence, indicate if changes were made, and distribute adaptations under the same licence.

Cataloguing field	Identifier / status
Digital Object Identifier (DOI)	Zenodo (CERN / OpenAIRE): 10.5281/zenodo.23605089
Open-access portal and updates	AlfiSurgery Clinical Education Platform (https://alfisurgery.com)
Author disclosures	The author declares no commercial conflicts of interest and no external industry funding.
Off-label use	Several recommendations involve off-label or unlicensed use in some countries (for example topical diltiazem, compounded nifedipine, and botulinum toxin for anal fissure). They reflect current guideline recommendations (ASCRS 2023) and must be checked against national licensing and local formularies.
Language and spelling	UK/international English. Drug names follow the International Non-proprietary Name (INN) where it differs (for example glyceryl trinitrate, paracetamol, aciclovir/valaciclovir).

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Dedication, Clinical Audit and How to Use This Handbook
What’s New in Version 2
Chapter 01 — Anatomy and Physiology in Three Minutes
Chapter 02 — Before You Assume Haemorrhoids
Chapter 03 — Haemorrhoids: Grading, BPRST, and Non-Surgical Mastery
Chapter 04 — Anal Fissure
Chapter 05 — Suppurative Disease: Abscess, Fistula, and Fournier’s Gangrene
Chapter 06 — High-Yield Gap-Fillers for the ER and Primary Care
Chapter 07 — Anal Cancer, AIN, and Non-Healing Lesions
Chapter 08 — Rectal Bleeding and Colorectal Cancer Triage
Chapter 09 — Perianal Crohn’s Disease and IBD
Chapter 10 — Faecal Incontinence, Constipation, and Pelvic-Floor Disorders
Chapter 11 — STIs, Proctitis, and Anorectal Sexual Health
Chapter 12 — Anorectal Trauma, Sexual Assault, and Foreign Bodies
Chapter 13 — Pregnancy, Postpartum, and Pelvic-Floor Disease
Chapter 14 — Paediatric and Adolescent Conditions
Chapter 15 — Rare but Important Conditions
Chapter 16 — The Safety Net: Red Flags, Drug Pitfalls, and Triage
Chapter 17 — Getting the Examination Right
Chapter 18 — Nursing and Multidisciplinary Team Excellence
Chapter 19 — Synthesis and Capstone Self-Test
Appendix A — Master Referral Form
Appendix B — Medication Safety Quick Reference
Appendix C — When Not to Do a DRE or Rectal Instrumentation
Appendix D — Post-Procedure Discharge Instructions
Appendix E — SBAR Handover Templates
Appendix F — Patient Education Pages
Final Quick-Reference Section
Consolidated Reference List
List of Tables and Algorithms
List of Recommended Medical Illustrations
Clinical Safety Review and Final Quality-Control Checklist

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Table of Contents