Nathalie Mantilla

By Nathalie Mantilla and Juaquito Jorge

Pruritus ani is a benign anorectal disorder characterized by an itching sensation of the perianal skin. It is a source of embarrassment and frustration for those who suffer from it. Multiple conditions can be responsible for perianal itching; however, most cases are idiopathic. Skin breakdown from constant scratching creates a vicious cycle exacerbating the symptoms. Empiric treatment resolves the problem in most cases, but additional testing should be performed when deemed necessary. Guided management to control associated diseases, lifestyle modifications, as well as skin protection, is paramount in the management.

Part of the book: Benign Anorectal Disorders

By Nathalie Mantilla and Juaquito M. Jorge

Chronic anal fissure is a common complaint that is associated with excruciating anal pain and bright red bleeding associated to bowel movements. The classic findings during the physical examination are helpful in differentiating the different types of fissures (acute versus chronic and typical versus atypical). Most cases of chronic anal fissures are successfully treated with conservative measures such as dietary and lifestyle modifications, adequate bowel regimen, and topical muscle relaxants such as nifedipine, diltiazem, or nitroglycerine. Refractory cases are usually managed with botulinum toxins injections or more invasive approaches such as internal lateral sphincterotomy with excellent healing rates at the expense of risk of fecal incontinence. In patients without hypertonicity of the anal sphincter, cutaneous flaps can be used with remarkable results.

Part of the book: Anorectal Disorders