Hemorrhoids differential diagnosis: Difference between revisions

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* [[Fissure|Anal fissure]] usually presents with tearing pain with every bowel movement.<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref>
* [[Fissure|Anal fissure]] usually presents with tearing pain with every bowel movement.<ref name="pmid27041801">{{cite journal |vauthors=Schlichtemeier S, Engel A |title=Anal fissure |journal=Aust Prescr |volume=39 |issue=1 |pages=14–7 |year=2016 |pmid=27041801 |pmc=4816871 |doi=10.18773/austprescr.2016.007 |url=}}</ref>
* Pain usually lasts for minutes to hours after every bowel movements.
* Pain usually lasts for minutes to hours after every bowel movements.
* Patient is typically afraid of going to the bathroom to avoid the pain, which leads to a viscious cycle. The fissure worsens the constipation and the constipation (hard stool) aggravates the fissure.
* Patient is typically afraid of going to the bathroom to avoid the pain, which leads to a viscious cycle. The [[Anal fissure|fissure]] worsens the [[constipation]] and the [[constipation]] (hard stool) aggravates the [[Anal fissure|fissure]].
* About two thirds of the patients present with bright red blood streaks on toilet papers or on the surface of stools.
* About two thirds of the patients present with bright red blood streaks on toilet papers or on the surface of stools.
* May be accompanied by pruritis and discharge.
* May be accompanied by [[pruritis]] and [[discharge]].
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* Most fissures occur in the posterior midline of the anal canal.<ref name="pmid26929749">{{cite journal |vauthors=Beaty JS, Shashidharan M |title=Anal Fissure |journal=Clin Colon Rectal Surg |volume=29 |issue=1 |pages=30–7 |year=2016 |pmid=26929749 |pmc=4755763 |doi=10.1055/s-0035-1570390 |url=}}</ref>
* Most [[Anal fissure|fissures]] occur in the posterior midline of the [[Anus|anal canal]].<ref name="pmid26929749">{{cite journal |vauthors=Beaty JS, Shashidharan M |title=Anal Fissure |journal=Clin Colon Rectal Surg |volume=29 |issue=1 |pages=30–7 |year=2016 |pmid=26929749 |pmc=4755763 |doi=10.1055/s-0035-1570390 |url=}}</ref>
* Skin tags in the perianal area may accompany chronic anal fissures.
* [[Skin tags]] in the perianal area may accompany chronic anal fissures.
|[[Image:Anal fissure 1 - By Bernardo Gui - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750.jpg|center|300px|thumb|Anal fissure - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750]]
|[[Image:Anal fissure 1 - By Bernardo Gui - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750.jpg|center|300px|thumb|Anal fissure - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750]]
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|Rectal [[prolapse]]
|[[Rectal prolapse]]
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* Rectal prolapse most commonly occurs in multiparous females over 40 years old.<ref name="pmid28144208">{{cite journal |vauthors=Cannon JA |title=Evaluation, Diagnosis, and Medical Management of Rectal Prolapse |journal=Clin Colon Rectal Surg |volume=30 |issue=1 |pages=16–21 |year=2017 |pmid=28144208 |doi=10.1055/s-0036-1593431 |url=}}</ref>
* [[Rectal prolapse]] most commonly occurs in multiparous females over 40 years old.<ref name="pmid28144208">{{cite journal |vauthors=Cannon JA |title=Evaluation, Diagnosis, and Medical Management of Rectal Prolapse |journal=Clin Colon Rectal Surg |volume=30 |issue=1 |pages=16–21 |year=2017 |pmid=28144208 |doi=10.1055/s-0036-1593431 |url=}}</ref>
* Progressive mass protrusion from the anus. Protrusion at first with straining and defecation then progresses to the degree that it is no longer be replaced.
* Progressive mass protrusion from the anus. Protrusion at first with straining and defecation then progresses to the degree that it is no longer be replaced back.
* It presents with abdominal discomfort and incomplete defecation.
* It presents with [[abdominal discomfort]] and incomplete defecation.
* Fecal incontinence and anal discharge.
* [[Fecal incontinence]] and anal discharge.
* Pain is not usually present.
* Pain is not usually present.
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Revision as of 20:34, 19 June 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defecation such as rectal cancer, anal fissure, anal abscess, anal fistula.

Differentiating Hemorrhoids from other Diseases

Hemorrhoids should be differentiated from other diseases causing anal discomfort and pain with defecation.

Disease History Physical exam findings Sample image
Anal fissure
  • Anal fissure usually presents with tearing pain with every bowel movement.[1]
  • Pain usually lasts for minutes to hours after every bowel movements.
  • Patient is typically afraid of going to the bathroom to avoid the pain, which leads to a viscious cycle. The fissure worsens the constipation and the constipation (hard stool) aggravates the fissure.
  • About two thirds of the patients present with bright red blood streaks on toilet papers or on the surface of stools.
  • May be accompanied by pruritis and discharge.
Anal fissure - Own work, Public Domain, httpscommons.wikimedia.orgwindex.phpcurid=8885750
Rectal prolapse
  • Rectal prolapse most commonly occurs in multiparous females over 40 years old.[3]
  • Progressive mass protrusion from the anus. Protrusion at first with straining and defecation then progresses to the degree that it is no longer be replaced back.
  • It presents with abdominal discomfort and incomplete defecation.
  • Fecal incontinence and anal discharge.
  • Pain is not usually present.
  • Mass protruding from the anus.[4]
  • Concentric mucosal rings are characteristic for rectal prolapse.
Rectal prolapse - By Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main - Dr. K.-H. Günther, Klinikum Main Spessart, Lohr am Main, CC BY 3.0, httpscommons.wikimedia.orgwindex.phpcurid=20649968
Perianal abscess
  • Perianal abscess presents with severe continuous dull aching pain in the perianal area.[5]
  • Pain is exacerbated with bowel movements but is not exclusive with it.
  • Constipation due to fear of bowel movements.
  • Fever, headache and chills might accompany the pain.
  • If abscess starts to drain, discharge of purulent or bloody fluid may be noticed.
  • Flatulent, erythematous and tender area of skin overlying the abscess.
  • If abscess is deep, tenderness is elicited with digital rectal examination.
Perianal abscess
anal cancer
  • Rectal bleeding is the most common presentation.[6]
  • Mass sensation in the anus.
  • Mucoid discharge may occur.
  • Patient may give a history of anal condyloma (especially homosexual men).[7]
  • Fecal incontinence.
  • On digital rectal examination, solid hemorrhagic mass that is firmly fixed to the surrounding structures is noted.
  • Femoral and inguinal lymph nodes may show lymphadenopathy secondary to spread of cancer.
Anal Cancer - By Internet Archive Book Images - httpswww.flickr.comphotosinternetarchivebookimages14598073128Source book page httpsarchive.orgstreamdiseasesofrectum00gantdiseasesofrectum00gant-pagen653mode1up, No restrictions, httpsc
Condylomata acuminata
  • Patient may give a history of anal unprotected sex with an infected partner.
  • Multiple sexual partners is a risk factor and should be investigated.[8]
  • Condyloma accuminata presents with a painless warts that varies in size, shape and color.
  • Pruritis and discharge might accompany the warts.
  • Anal condyloma accuminata may be accompanied by cervical, vaginal or even ororpharyngeal warts, so the patient should be examined thoroughly.[9]
Condylomata acuminata

References

  1. ↑ Schlichtemeier S, Engel A (2016). "Anal fissure". Aust Prescr. 39 (1): 14–7. doi:10.18773/austprescr.2016.007. PMC 4816871. PMID 27041801.
  2. ↑ Beaty JS, Shashidharan M (2016). "Anal Fissure". Clin Colon Rectal Surg. 29 (1): 30–7. doi:10.1055/s-0035-1570390. PMC 4755763. PMID 26929749.
  3. ↑ Cannon JA (2017). "Evaluation, Diagnosis, and Medical Management of Rectal Prolapse". Clin Colon Rectal Surg. 30 (1): 16–21. doi:10.1055/s-0036-1593431. PMID 28144208.
  4. ↑ Blaker K, Anandam JL (2017). "Functional Disorders: Rectoanal Intussusception". Clin Colon Rectal Surg. 30 (1): 5–11. doi:10.1055/s-0036-1593433. PMID 28144206.
  5. ↑ Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK (2017). "Perianal abscess". BMJ. 356: j475. PMID 28223268.
  6. ↑ Moureau-Zabotto L, Vendrely V, Abramowitz L, Borg C, Francois E, Goere D, Huguet F, Peiffert D, Siproudhis L, Ducreux M, Bouché O (2017). "Anal cancer: French Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up". Dig Liver Dis. doi:10.1016/j.dld.2017.05.011. PMID 28610905.
  7. ↑ Prigge ES, von Knebel Doeberitz M, Reuschenbach M (2017). "Clinical relevance and implications of HPV-induced neoplasia in different anatomical locations". Mutat. Res. 772: 51–66. doi:10.1016/j.mrrev.2016.06.005. PMID 28528690.
  8. ↑ Wieland U, Kreuter A (2017). "[Genital warts in HIV-infected individuals]". Hautarzt (in German). 68 (3): 192–198. doi:10.1007/s00105-017-3938-z. PMID 28160045.
  9. ↑ Köhn FM, Schultheiss D, Krämer-Schultheiss K (2016). "[Dermatological diseases of the external male genitalia : Part 2: Infectious and malignant dermatological]". Urologe A (in German). 55 (7): 981–96. doi:10.1007/s00120-016-0163-9. PMID 27364818.

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