ANORECTAL CONDITIONS

PREPARED BY:
MANISHA THAPA
ROLL NO: 6
BSN 2ND YEAR
PRESENTED TO : MS. SHRISTHI
SHRESTHA
 ANAL FISSURE 1

An anal fissure is a longitudinal tear or

ulceration in the lining of anal canal. Tears
generally occur just inside opening, if
fissures have persisted for three or more
months, additional changes may be seen.
 CAUSES 2

 Trauma of passing a large, firm stool

 Infection, inflammation
 Persistent tightening of anal canal because of stress anxiety
(leading to constipation)
 Chronic diarrhea
 Overuse of laxatives
 Child birth
 TYPES 3

 PRIMARY ANAL FISSURE

 It occurs as a result of local trauma associated with
defecation. When there is high pressure in internal anal
sphincter, it can result in ischemia which can lead to
fissuring.

 SECONDARY ANAL FISSURE

 It occurs because of any inflammatory bowel disease,
prior anal surgery, infection (herpes simplex virus, HIV,
STDs)
 EPIDEMIOLOGY 4

 Common in infants, women after childbirth and people with

crohn disease.
 Occurs at any age.
 Affect males and females equally; however, an anterior
fissure is more likely to develop in women (25%) than in men
(8%). 
PATHOPHYSIOLOGY 5
Constipation

Hard faeces

Tear in anal canal mucosa (fissure)

Severe anal pain

Spasm of the internal sphincter

Impairment of intersphincteric blood circulation

Impaired healing

Chronic Anal Fissure

SYMPTOMS 6

 Pain during and after defecation.

 Burning sensation during defecation.
 Bleeding with defecation.
 Bright red blood either on the toilet tissue or in the bowel.
 Itching of anus.
 Small amount of mucous in the stool.
 TREATMENT 7

 Dietary modification with addition of fiber supplements.

 Stool softener, sitz bath.
 Bulk agents.
 Increase water intake, emollient suppositories.
 A suppository combining an anesthetic with a corticosteroid helps relieve the
discomfort.
 Anal dilation under anesthesia may be required.
 It requires 2-4 weeks to heal.
 Bowel regulation with enema and stool softener.
PILONIDAL SINUS/ CYST 8

 Pilonidal means “a nest of hair”. Pilonidal sinus/cyst is an infection of the hair follicles in
the sacrococcygeal area above the anus. The terms pilonidal sinus and pilonidal cyst are
both used to describe the condition.
 CAUSES 9

 Combination of changing hormones.

 Hair growth.
 Friction form clothes.
 Spending long time sitting.
 Pilonidal cysts appear after a trauma to that region of
body.
 EPIDEMIOLOGY 10

 Age - Typically in the late teens to early twenties,

uncommon after 40 years of age
 Gender – Adult = M: F (3:1)
 Race – Predominantly in white
 PATHOPHYSIOLOGY 11

Acquired condition- enlarged and deformed hair follicles in natal cleft

Entrance of Bacteria

Causes local inflammation sealing mouth and creating abscess

When abscess breaks into subcutaneous fatty tissue

Leads to pilonidal sinus / cyst

SIGNS AND 12
SYMPTOMS

Pain when sitting or standing.

Swelling of cyst.
Reddened, sore skin around the area.
Pus or blood draining from abscess causing a foul odor.
Hair protruding from the lesion.
Formation of more than one sinus tract or holes in the
skin.
 TREATMENT 13

 If there is sign of inflammation doctor will prescribe a

broad-spectrum antibiotic. (just to relief from infection and
discomfort).
 Removal of hair or shave the site.
 Pay particular attention to hygiene.
 Avoid sitting for a long time.
 ANORECTAL ABSCESS 14

 Anorectal abscess is an infection with collection of pus in an area between the internal and
external sphincter. Infection originates most often from an obstructed anal crypt gland. Pus
builds up in the rectum and anus. The rectum is the area of the large intestine where stool
(faeces) are stored and the anus is the opening through which they are passed.
CAUSES 15

 Anorectal abscesses can be caused by:

 A blocked gland.
 An infection of an anal fissure (a tear or ulcer in the lining of the anal canal).
 A sexually transmitted infection (STI).

 People who are most susceptible to getting abscesses are:

 People with inflammatory bowel disease.
 People with diabetes.
 People with a weakened immune system.

With prompt treatment, people with this condition usually recover very well.
Complications tend to occur when treatment is delayed.
 EPIDEMIOLOGY 16

 Peak incidence : 3rd and 4th decades of life.

 Men are affected more frequently than women 2:1.
 Quite common in infants too.
 Relation
between the formation of anorectal abscess
and bowel habits .
PATHOPHYSIOLOGY 17

Obstruction of anal canal duct.

Stasis and bacteria growth of anal gland (cryptoglandular infection)

Abscess formation initially in intersphincteric space

Then spread along adjacent spaces

Anorectal abscess
SIGNS AND SYMPTOMS 18

 Painful, hardened tissue around the anus.

 Discharge of pus from the rectum.
 A lump or nodule at the edge of the anus.
 Tenderness at the edge of the anus.
 Fever.
 Constipation.
 Pain associated with bowel movements.
 Pain is usually constant, throbbing and worse when sitting down.
 Fatigue.
 TREATMENT 19

 Surgery to drain the abscess which may be done under local or

general anesthetic depending upon the extent and location of the
abscess. The wound is left open (there are no stitches) and the
wound is packed with a dressing. This is the best way to heal the
wound whilst reducing the risk of the abscess reforming.
 Medication for pain relief.
 Antibiotics are usually not necessary unless you are diabetic or
have problems fighting infection.
 Stool softeners to ensure that you do not get constipated.
 Nursing process: (the patient with an anorectal 20
condition)

 ASSESSMENT
 Asses for the presence and characteristics of itching, burning or pain related to elimination
patterns and laxative use, diet history (including fiber intake).
 Others related to amount of exercise, activity levels and occupation (especially one that
involves prolonged sitting or standing).
 Assessment also includes inspection of stool for blood or mucus & the perianal area for
fissures, irritation or pus.
DIAGNOSIS 21

Based on assessment data, the major nursing diagnosis may

include:
 Constipation related to ignoring the urge to defecate because of
pain during elimination.
 Anxiety related to impending surgery and embarrassment.
 Acute pain related to irritation, pressure and sensitivity in the
anorectal area from disease.
 Risk for ineffective therapeutic regimen management.
 PLANNING & GOALS 22

The major goals for the patient may include:

 Adequate elimination patterns.
 Reducing anxiety.
 Pain relief.
 Managing the therapeutic regimen.
 23
 NURSING INTERVENTIONS
 RELIEVING CONSTIPATIONS
 Encouraged intake of at least 2 liter of water daily to provide adequate hydration & recommend
high fiber foods to promote bulk in the stool to make it easier to pass.
 REDUCING ANXIETY
 Identify the specific psychosocial needs after facing rectal surgery and individualize the plan of
care. Including patient's privacy, discomfort, pain & embarrassment, limiting visitors.
 RELIEVING PAIN
 Encourage to assume a comfortable position, flotation pads under the buttocks when sitting,
analgesic ointments, sitz bath.
 MONITORING AND MANAGING COMPLICATIONS
 Assess the patient for systemic indicators of excessive bleeding (i.e. tachycardia, hypotension,
restlessness and thirst).
REFERENCES 24

 Brunner & Suddharth’s text book of Medical Surgical Nursing (10th edition)
 Mandal GN (2018). "Textbook of Medical Surgical Nursing: Makalu publication Dillibazzar,
Kathmandu (Pg. no 182-183)
 www.medscape.com