Anal emergencies. Part 2: Pain

Anorectal pain is a common cause for contacting a proctologist. Symptoms often occur acutely as an emergency, requiring immediate diagnosis and treatment. Common reasons for urgent anal pain include anal abscess, acute fissure-in-ano and thrombosed hemorrhoidal disease. However, anal eczema and various forms of proctitis can also cause impairments. Patient history alone makes it possible to narrow down the problem: anal abscess is characterized by acute-onset pain, whereas pain caused by thrombosis diminishes over time. Pain during and after defecation is typical for anal fissure. Uncharacteristic "pain" over a long period of time in combination with itching is typical for anal eczema. Based on the combination of patient history and clinical examination, if necessary including rectoscopy, it is possible to make the correct diagnosis and focus on urgent treatment.