Besides fissures, another common cause of peri-anal pain is a peri-anal abscess. An abscess is a collection of pus. This is due to an infection in the region around the anus.

Usually an abscess causes persistent, throbbing pain. It is present even if the patient is not doing anything. However, the pain may get worse during bowel movement, sitting down or when the area is touched. When examined, redness, warmth and a tender swelling may be often found. (Tenderness in medical jargon means “painful when touched”.) Sometimes, however, it may just be tender to touch with no visible signs. Not a few abscesses have been missed because there were initially no visible signs although there was tenderness. Fever may be present.

The treatment of an abscess is by drainage (i.e. releasing the pus from the abscess and allowing any further pus formation to flow out). This is accompanied by an antibiotic. The wound is left open and dressed regularly until the opening shrinks and closes by itself.

Here is an abscess which had been drained. This patient complained of painful piles. He had piles too, for many years. He was receiving treatment for piles and uncontrolled diabetes. Now, however, the pain was due to the abscess. The sign which gave the abscess away was the presence of tenderness not directly over the piles.

After drainage, the pain subsided and diabetes came under control. The wound healed over a period of 2 weeks. The piles resolved by just a change of dietary and toilet habits.

Many people assume that pain in the anus equals piles. When they see a doctor, they complain, “Doctor, I have piles” instead of “Doctor, I have pain in the anus.”

In fact, there are many causes of pain in the peri-anal region (around the anus). The most common cause is probably an anal fissure. This is a split in the skin at the anus. The break is due to passage of hard stools through a tight anal sphincter (anus control muscle). There is sharp pain during passage of motion, followed by a small amount of bright, red blood. The pain subsides after the event; only to recur every time there’s passage of hard stools. The pain causes the anal sphincter muscles to get even tighter. This ends up as a vicious cycle of tight anal sphincter, hard motion and fissuring.

The diagnosis is easily made by visual inspection of the anus. That’s all it takes. No further examination can be made until the fissure heals (because of the pain). After healing, further examination is justified to look for other causes of pain and bleeding deeper in the anal canal.

The treatment is to break the vicious cycle of tight sphincter - hard stools - fissuring. Adequate fibre in the diet and supplemented by syrup lactulose (makes stools soft) will go a long way to enable gentle passage of stools. An analgesic (i.e. a pain-killer) may be required during the acute, painful period of the fissure. Most fissures will heal with just these.

Some non-healing fissures may require more complicated therapy. To relax the anal sphincter, there are a few methods. One way is to apply glyceryl trinitrate (as used by heart attack patients) to relax the muscles. Another method is botox injection (same as the botox for treatment of facial wrinkles) into the muscle. However, the standard is an operaton to divide some of the fibres of the anal sphincter muscle in order to relax it.

Easy as toast. So, boys and girls, don’t say “Doctor, I’ve got piles.” Say, “Doctor, I’ve got pain, please examine me and see what’s wrong.” Tomorrow: another cause of peri-anal pain.

Ever heard of this place? I’ve passed this place a few times before, but last weekend was the first time I actually went there. It was a combined church family camp (from a Sungai Petani church and the sister church in Arau, Perlis) from Friday to Sunday.

In spite of its name, Hosba Valley is NOT a cowboy town. It’s just south of Changloon and Bukit Kayu Hitam, in Kedah, along the PLUS highway. We went to a place called Seri Kedah Gardeniaa Resort which is built on the lush, green, rolling hills of Hosba, 4 km from the highway.