Anorectal Problems

What is Anal Cancer?

Anal cancer, an uncommon cancer, is a disease in which cancer (malignant) cells are found in the anus. The anus is the opening at the end of the rectum (the end part of the large intestine) through which body waste passes. Cancer in the outer part of the anus is more likely to occur in men; cancer of the inner part of the rectum (anal canal) is more likely to occur in women. If the anus is often red, swollen, and sore, there is a greater chance of getting anal cancer. Tumors found in the area of skin with hair on it just outside the anus are skin tumors, not anal cancer.

A doctor should be seen if one or more of the following symptoms appear: bleeding from the rectum (even a small amount), pain or pressure in the area around the anus, itching or discharge from the anus, or a lump near the anus.

If there are signs of cancer, a doctor will usually examine the outside part of the anus and give a patient a rectal examination. In a rectal examination, a doctor, wearing thin gloves, puts a greased finger into the rectum and gently feels for lumps. The doctor may also check any material on the glove to see if there is blood in it. The doctor may give the patient general anesthesia, medicine that puts patients to sleep, to continue the examination if pain is felt during it. The doctor may cut out a small piece of tissue and look at it under a microscope to see if there are any cancer cells. This procedure is called a biopsy.

Anal cancer is an uncommon malignancy, accounting for only a small percentage (4%) of all cancers of the lower alimentary tract. Clinical trials have evaluated the roles of chemotherapy, radiation therapy, and surgery in the treatment of this disease.

Overall, the risk of anal cancer is rising, with data suggesting that individuals with human papillomavirus, and male homosexuals in particular, are at increased risk of anal cancer.

The prognosis (chance of recovery) and choice of treatment depend on the stage of the cancer (whether it is just in the anus or has spread to other places in the body) and the patient’s general health.

Anal cancer is an often curable disease. The 3 major prognostic factors are site, size, and differentiation (well-differentiated tumors are more favorable than poorly differentiated tumors). Squamous cell (epidermoid) carcinomas make up the majority of all primary cancers of the anus. The important subset of cloacogenic (basaloid transitional cell) tumors constitute the remainder. These two histologic variants are associated with human papillomavirus infection.

What is Anorectal Abscess?

An anorectal abscess is a pocket of pus in the tissue near the end of the rectum (anus). Most abscesses are caused by a blocked anal gland that develops an infection.

Other possible causes of an anorectal abscess include:

  • Infection in an anal fissure.
  • Complications of diseases that affect the colon, such as Crohn’s disease, inflammatory bowel disease, or diverticulitis.
  • Sexually transmitted diseases.

Symptoms of an anorectal abscess include:

  • A painful swelling (mass) around the anus.
  • Drainage of pus from the anus.
  • Fever.
  • Pain in or around the anus.
  • Pain when passing stool.

A person should see a health professional if an anorectal abscess is suspected. Treatment is necessary to prevent worsening of the infection and serious illness.

What is Anal Warts (Condyloma)?

Venereal warts are sexually transmitted diseases that infect the anal and genital areas. They usually spread from person to person by sexual contact. They can also spread from inanimate objects, such as a shared bath towel. Approximately two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within three months of contact. Scientists estimate that as many as 1 million new cases of anal and genital warts are diagnosed in the United States each year. There are two types of venereal warts, condyloma accuminatum and condyloma latum.

Condyloma latum are reddish, moist warts, and are a sign of secondary syphilis. These warts are treated by treating the underlying syphilis infection with antibiotic.

Condyloma accuminatum are pink to whitish growths that occur on the anus and genitalia as a result of infection with the papilloma virus. The Human Papilloma Virus (HPV) is one of the most common viral sexually transmitted diseases (STD) in the United States today. As many as one in five American adults has a genital HPV infection. They occur on the penis, the vagina, the anus, and rarely, the mouth. In the anal area they may be mistaken for hemorrhoids. They are spread by contact with the wart, which actively sheds viral particles. They grow geometrically and may become extensive. (Warts on other parts of the body, such as the hands, are caused by different types of HPV. Contact with these warts does not seem to cause genital warts).

Treatments are directed as destruction of the wart tissue to allow for normal healing. Some work has been done with immunotherapy and a commercial preparation of alpha interferon is available. The alpha interferon is injected into the wart which stimulates an immune response causing the wart to disappear. The problem with the therapy is the alpha interferon is quite expensive and doesn’t work in all cases. Imiquimod cream is a self-applied immune response modifier that induces local production of interferon in patients with external genital warts.

Though genital warts can be treated, none of the available treatments are a cure for HPV. The virus can remain in nearby skin after treatment. Because the virus can lie dormant in the cells, in some cases warts can return months or even years after treatment. In other cases, warts never recur.

More reliable is wart destruction. This may be accomplished chemically with an acid compound, liquid nitrogen, or with surgery. The acid compounds are chemical cauterants which burn off the wart. Cryotherapy, or the application of liquid nitrogen to the wart tissue destroys it by freezing it. Warts may also be destroyed by electrocautery or vaporization with a CO2 laser. This is done as an outpatient at a hospital or a outpatient surgical facility. Even with surgical destruction of all warts the patient must still be carefully followed for the development of recurrence. At the time of surgery all visible warts are destroyed but it may take up to 30 days before infected tissue shows signs of wart development. It is therefore very important that prolonged follow-up be performed to assure cure.

What is Rectal Itching?

Rectal itching (pruritus) is usually not a sign of a serious disease. At first, the skin of the anal area may appear red. Itching and scratching may make the skin become thickened and white. Common causes of rectal itching include:

  • Poor cleaning of the area after a bowel movement. Itching and discomfort may occur when pieces of stool become trapped in skin folds around the anus.
  • Medications, especially medications that cause diarrhea or constipation, such as antibiotics.
  • A chronic disease, such as diabetes , psoriasis , seborrhea , or cirrhosis of the liver.
  • Cleaning of the anus with very hot water and strong soaps. The anal area is normally oily, and this barrier protects against the irritation of bowel movements. Repeated cleaning or showering will remove these oils and can lead to a cycle of itching and scratching that can be hard to stop.
  • Tight clothing. Avoid wearing panty hose, tight jeans, and underwear made from synthetic materials such as nylon.
  • The use of scented toilet paper, scented soap, or ointments (such as those that contain benzocaine).
  • A generalized dry skin condition that affects the entire body. This condition is more common in older adults
    Hemorrhoids . Hemorrhoids are enlarged veins near the lower end of the rectum or outside the anus.
  • An infection of the anus or rectum which may be caused by viruses (such as genital warts ), bacteria , pinworms , scaies , fungus, yeast, or parasites. Pinworms are the most common cause of anal itching in children.
  • Certain foods, such as coffee, tea, cola, alcoholic beverages, chocolate, tomatoes, spicy foods, and large amounts of vitamin C.

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