Fissures, pruritus ani and haemorrhoids

Benign anal diseases are common. Patients may present with a variety of symptoms including pain, itching or bleeding. It is important for a surgeon to be able to accurately diagnose and treat these conditions. This article discusses the basic anatomy of the anal canal and the common causes, investigation and treatment of anal disease. Fissures are linear ulcerations in the anal canal of unknown aetiology and are a common cause of pain and bleeding. Treatment can involve both pharmacological and surgical management. Many people will suffer with pruritus ani at some point in their lives. Most causes are benign but it is essential to perfom sufficient investigation as it can be a marker of some important diseases. Haemorrhoids occur in 4-36% of the population and often present with fresh rectal bleeding. Outpatient management is successful in the majority of patients but surgical intervention is sometimes required.