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| Anal problems |
By:
Robert Carlos |
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The British have always had a great love affair with their bowels. As a GP I can’t count the number of hours I’ve spent talking about diarrhoea, haemorrhoids, constipation and rectal bleeding. Grim subjects, believe me, but strangely essential.
Anal conditions are very common, enjoying a mix of environmental factors such as dietary, constipation or diarrhea, hygiene and infections. Splits in the anal skin, sometimes down to the muscle, are known as anal fissures and can be exquisitely painful with bleeding and forced constipation because you daren’t go to the loo for fear of activating the pain. Anal fissures are difficult to sort out. Scrupulous hygiene using a very mild soap after going to the toilet and drying your anal area thoroughly are helpful. Your doctor may prescribe some GTN or diltiazem cream to relax your muscles. Surgery can be an option and I use Botox to relax the muscles locally.
Anal cancers are increased amongst gay men and caused by some human papilloma viruses (HPV), much like cervical cancer in women. The rate of anal cancer in HIV positive people is much greater at 75 per 100,000 and some doctors; especially in the US are advocating anal cancer screening. This is available in the UK but only currently as research projects or in private practice. It involves taking a smear of your anus and then grading the result. Treatment is by STD testing, laser or cold destruction of any suspicious lesions. Anal cancers might well be prevented this way and the destructive anal cancer treatment avoided.
Haemorrhoids are anal or rectal blood vessels which are pushed out of the anus and may cause bleeding, itch, pain or lumps, or all of these together. They are exceptionally common and are due to fibre-poor diet, water-poor diet and an upright posture. Treatment involves changing your diet to get lots of preferably mixed fibre and fluid so as to develop big, firm but mushy stools. Treating acute piles needs ice packs, local anaesthetic creams and sometimes anti-inflammatory medications like ibuprofen. Very occasionally with acutely painful very large haemorrhoids an incision into the haemorrhoid will release the clotted contents and allow enormous pain relief.
Anal warts cause an inordinate amount of distress. These are accumulations of unattractive skin around or inside the anus caused by another human papilloma virus. There’s an important distinction here – HPV’s causing external physical appearance of warts do not cause cancers but HPV’s which don’t result in obvious warts might, particularly sub types 16, 18, 31 and 45. So external genital and anal warts do not cause cancer but are generally unpleasant. They will disappear on their own but take a long time. You can accelerate this by using creams, lasers, cryotherapy, surgery, and cautery. All work as well as each other. Discuss the most convenient with your doctor. I use cryotherapy, spraying liquid nitrogen onto the wart or laser destruction because it’s quick, very effective and not painful. Sometimes I combine it with creams. Strictly you’ll be infectious, but estimates are that 70% of the population carries wart virus on the skin but only 1-2 % have warts.
Other infections include herpes which causes acutely painful, blistering lesions around and in the anus about 4 days after your exposure. Your doctor may take swabs but generally diagnosis is by appearance alone. Treatment is by using acyclovir as and when attacks appear. Herpes isn’t curable but is supremely manageable so discuss with your GP or GU doctor.
Occasionally, some people develop a bacterial infection called staphylococcus or streptococcus. This causes bleeding, crusting sore lesions often with spreading skin infection around the anus. Diagnosis is by physical examination and probably swabs. Treatment is by using organism-specific antibiotics.
Syphilis is back with a vengeance and often in disguise. It can look like many things. Be suspicious of any non-healing lesion of any description on your genitals or mouth. Forget all those web-pictures of syphilitic sores – it often looks completely different. Get an experienced doc or nurse to look. You may need a blood test. If you know you’ve had sex with someone with syphilis then get treated.
The author is a General Urologist by profession for which he has gathered good information on STD Testing, Microdermabrasion, Sexual health clinic, HIV Testing. For more information on Anal problem visit at: - www.freedomhealth.co.uk |
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