Common Anal Conditions: A Patient Guide

Quick guide: what might I have?

• Bright red blood on the paper or in the toilet, little or no pain: often haemorrhoids.
• Sharp, burning pain during and after passing stool: often an anal fissure.
• Throbbing pain, a hot swollen lump, maybe fever: possibly an abscess. See a doctor the same day.
• Repeated discharge or a small opening near the anus: possibly a fistula.
• Constant itching or irritation: often pruritus ani.

Only an examination can confirm the cause, so do not rely on this list alone.

Haemorrhoids (piles)

Haemorrhoids are soft cushions of blood vessels inside the anal canal. They become a problem when they swell.

Common signs: painless bright red bleeding, a lump that comes out when passing stool, itching, a feeling of incomplete emptying.

What helps:

• More fibre (vegetables, fruit, whole grains) and plenty of water.
• Do not strain, and do not sit on the toilet for long (avoid phones).
• Warm sitz baths for 10 to 15 minutes.
• Creams or suppositories your doctor recommends for symptom relief.
• Office procedures such as rubber band ligation for persistent symptoms.
• Surgery for large or complicated haemorrhoids that do not respond to other treatment.

Anal fissure

A fissure is a small tear in the lining of the anus, usually caused by passing a hard stool.

Common signs: sharp pain during a bowel movement that can burn for hours afterwards, a little bright red blood, fear of going to the toilet.

What helps:

• Fibre, fluids and a stool softener if prescribed.
• Warm sitz baths after bowel movements.
• Prescription ointments that relax the anal muscle and help healing.
• If a fissure lasts more than about 6 to 8 weeks, further options include botulinum toxin injection or a small operation. Your surgeon will explain the choices.

Perianal abscess

An abscess is a collection of pus near the anus caused by infection of a small gland.

Common signs: increasing throbbing pain, a red, hot, tender swelling, fever, pain when sitting.

Treatment: an abscess usually needs to be drained by a surgeon. Antibiotics alone are normally not enough. Do not wait, because delay can allow the infection to spread.

Anal fistula

A fistula is a small tunnel that connects the inside of the anus to the skin nearby. It often follows an abscess.

Common signs: a small opening on the skin, repeated discharge or pus, recurring abscesses, skin irritation.

Treatment: a fistula rarely heals on its own. Surgery is usually needed, and the type depends on how close the tunnel is to the muscles that control continence. Your surgeon will plan the operation to treat the fistula while protecting these muscles.

Itching around the anus (pruritus ani)

This is a persistent, often worse-at-night itch with many possible causes: moisture, over-cleaning, skin conditions, haemorrhoids or leakage.

What helps:

• Gently clean with water and pat dry. Avoid scrubbing.
• Avoid scented soaps, wipes and creams unless prescribed.
• Wear loose cotton underwear.
• Do not scratch. See a doctor if it lasts more than a couple of weeks.

Prevention: habits that protect you

• Aim for a high-fibre diet and drink enough water daily.
• Respond to the urge to go, and do not strain.
• Keep active and maintain a healthy weight.
• Treat constipation or diarrhoea early.