Painful arse,
commonly caused by constipation,
leading to anal fissure,

may be due to rimming...

It cause cold sore,
require sitz bath to treat...

Painful arse commonly caused by constipation leading to anal fissure,may be due to rimming causing cold sore,require sitz bath to treat...

client complaint of pain on sitting,prefer to stand,feel like shitting razorblades.Occasionally itchy.

Causes of painful arse,backside:

-commonest
1. anal fissures
-Notes; *most people assume piles are the culprit.Actually piles are never painful,instead cause painless bleeding, unless strangulated
-anal fissure are now intensely studied
-fissure result from
.increased anal resting tone
.poor blood supply on peri-anal sub-mucous tissues
.the resultant increased pressure from defecation,especially constipation,cause 'strain at stool',leading to local decreased blood supply,breakdown of covering mucosa,with resultant ulcer,thus the anal fissures

* it usually occur at mid line on the back 6 o'clock position.

* young adult get it frequently,with equal sex distribution.

2. peri-anal abscess
-pain is severe, deep, throbbing
-is associated wit systemic malaise fever
-pain worsen with defecation
-3 times more common in male
-firm or fluctuation ,tender,red swelling around anus-pain on walking.So,refer to stand or lying than sitting

3 anal cold sore,or herpes simplex type 1 infection
-worst with primary,or 1st episode infection,associated with constipation and unable to pass urine
-systemic malaise,fever,headache,
-nearly always history of anal sex few day ago
-can be caused by rimming,or oral anal contact

uncommon causes of painful arse

-Crohn disease
-leukemia,
-HIV

Tips on prevention ,treatment:

1.stretch the over constricted anus
-with 10 fingers to loosen and disrupt sphincter .This will allow healing
-it is of course painful.After anesthesia, only then you perform this.
- this is called Lord's procedure

2. acute anal fissure are treated with
.dietary advise with high fiber and fluid
.avoid straining on passing motion

3.
.analgesia before motion
.GTN, glyceryl trinitrate 0.2% ointment several time a day to relax sphincter,allowing increased blood flow to mucosa promote healing of mucosa and fissure .

4.Botox
-injected into internal anal sphincter cause relaxation ,allowing more blood supply to anal mucosa covering.

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