Use of diclofenac suppositories in pain management in acute fissure in ano in outpatient department care

Background: Per anal diseases and the pain management in such cases have always been a problematic solution for surgeons. There are various pain management methods for per anal cases, however we wanted a cheaper yet effective way and patient friendly method for pain management where no expertise would be required, hence we opted to see results of diclofenac suppositories which were easily available, patient could insert it without anyone’s help or assistance and hence need not be hospitalized for any intravenous analgesics.Methods: A study was conducted over 2000 cases over a span of 6 years in a tertiary centre. A control group A of 1000 patients was made where, oral (tablet diclofenac) plus local analgesics (xylocaine gel) were opted for whereas the other group B of 1000 patients was treated with diclofenac suppository 100 mg twice a day with glycerin as lubricant at anal verge. The pain score was noted in both the groups. All acute fissure in ano cases, we included in this study.Results: The pain score of the group B cases was much lower than the group A cases, and also the duration of results acquired was much lesser than group A.Conclusions: Diclofenac suppository 100 mg twice a day proved to be an excellent pain management method for acute fissure in ano cases in outpatient department care.

A Case of Anal Prolapse of Internal Hemorrhoids with Anal Pain Successfully Treated with Teikosan / 日本東洋医学雑誌

Teikosan is an herbal medicine that was developed from the Japanese herbal (Kampo) medicine hochuekkito. Unlike hochuekkito, teikosan does not include Zizyphi fructus and Zingiberis rhizoma. Instead, Cnidii rhizoma, Scutellariae radix, Coptidis rhizoma, Angelicae dahuricae radix, and shakusekishi are included as constituents of teikosan. The clinical indication of teikosan is anal prolapse with pain that is more severe than that considered appropriate for hochuekkito treatment, but there have been few clinical reports before. Here, we describe a case of anal prolapse with anal pain, which was successfully treated with teikosan. A case was a 47-year-old woman whose chief complaint was anal prolapse of internal hemorrhoids with pain. She was considered as indication for hochuekkito, but her symptoms including anal pain were so severe that we prescribed teikosan, especially because Angelicae dahuricae radix, Scutellariae radix, Coptidis rhizome in teikosan were expected to improve her anal pain. After the administration of teikosan, her symptoms including anal pain have much improved. Teikosan should be considered as a therapeutic option for anal prolapse with severe anal pain or inflammation.

Study on the analgesic effect of lidocaine and methylene blue on the analgesia of anal pain after hemorrhoids / 中国生化药物杂志

Objective To investigate the effects of lidocaine and methylene blue on the analgesia of the anal pain after hemorrhoids. Methods Using computer random way, to the hospital from January 2014 to October 2016 postoperative anal pain patients, 52 cases of hemorrhoids were randomLy divided into normal group and research group, 26 cases of each item, which the conventional pain processing, conventional group team to lidocaine and methylene blue, compared two groups of patients with analgesic effect and the incidence of adverse reactions. Results 1d, 3d, 5d and 7d were performed after surgery, and the VAS pain score of the study group was lower than that in the conventional group, and the results of the test were statistically significant (P<0.05). Statistical incidence of adverse reactions in both groups, found the team vomiting nausea, headache, dizziness and transient hypertension incidence of adverse reactions, significantly lower than the normal group, the difference between groups with the clinical inspection was statistically significant (P<0.05). Conclusion The postoperative anal pain, hemorrhoids application of lidocaine and methylene blue, can obtain satisfactory analgesia effect, operation method is simple, low incidence of adverse reactions, safe and reliable, and can use it as a clinical analgesic solution recommended applications.

The importance of three-dimensional anorectal ultrasound in the study of patients with anal pain / A importância da ultra-sonografia anorretal tridimensional no estudo de pacientes portadores de dor anal

OBJECTIVES: Anal pain can be caused by various medical conditions; the exclusion of organic causes for proper treatment is important. Three-dimensional anorectal ultrasound can identify organic causes of anal pain. The objective of this study was to evaluate the importance of three-dimensional anorectal ultrasound in the detection of organic abnormalities in patients with anal pain. METHODS: Twenty-two patients (mean age: 49 years; 13 women) with chronic anal pain were enrolled to join a prospective study between June 2009 and June 2011. A complete proctology and colonoscopy examination was normal. Subsequently, the patients underwent three-dimensional anorectal ultrasound. RESULTS: Intersphincteric sepsis was found in 14 patients (63.6%). Two female patients (9.1%) had anal sphincter injury, one of them with the presence of a grade II rectocele. There was an increase in the thickness of the subepithelial tissue in three patients (13.6%). In one patient (4.6%), the presence of a hypoechoic circular retrorectal (presacral) cyst of the middle and lower rectum was observed. The three-dimensional anorectal ultrasound examination showed no abnormalities in two patients (9.1%). CONCLUSION: The three-dimensional anorectal ultrasound is a simple, economical, fast and useful test for the study of anorectal diseases and should be included in the examination of patients with anal pain, to exclude organic causes. (AU)

OBJETIVOS: A dor anal pode resultar várias condições clínicas e se faz necessário excluir causas orgânicas para o tratamento adequado. A ultra-sonografia anorretal tridimensional (3D-US) pode identificar causas orgânicas de dor anal. O objetivo deste estudo foi avaliar a importância da 3D-US para detectar anomalias orgânicas em pacientes com dor anal. MÉTODOS: Vinte e dois pacientes (média de idade: 49 anos; treze mulheres) com dor anal crônica foram incluídos em um estudo prospectivo entre junho de 2009 e junho de 2011. O exame proctológico completo e colonoscopia foram normais. Posteriormente, os pacientes foram submetidos à 3D-US. RESULTADOS: Sepse interesfincteriana foi evidenciada em quatorze pacientes (63,6%). Duas pacientes (9.1%) apresentaram lesão do esfíncter anal, sendo uma com presença de retocele grau II. O aumento da espessura do tecido subepitelial apresentou-se em três pacientes (13,6%). Em um paciente (4,6%), foi evidenciada a presença de cisto retrorretal circular hipoecoico no reto médio e inferior. O exame de US-3D não evidenciou anormalidades em dois indivíduos (9.1%). CONCLUSÃO: A ultra-sonografia anorretal tridimensional é um exame simples, econômico, rápido e útil no estudo de doenças anorretais e deve ser incluído no estudo dos pacientes com dor anal para descartar causas orgânicas. (AU)

Successful elimination of intractable anal pain associated with rectal cancer by combination of subarachnoid phenol block with sacral nerve root thermocoagulation

<b>Purpose</b>: We report a case whose anal pain accompanied by rectal cancer was remarkably eliminated by subarachnoid phenol block and sacral nerve root thermocoagulation. <b>Case Report</b>: The subject was a sixty-one-year old male. His anal pain failed to respond to opioid whereas his pain was alleviated by subarachnoid phenol block, but was exacerbated a few weeks later. This relapsing pain was completely eradicated by sacral nerve root thermocoagulation. <b>Conclusion</b>: Anal pain associated with rectal cancer recurrence of pelvic space is sometimes hard to be controlled only by subarachnoid phenol block, but there is a possibility of pain control by combination use with sacral nerve root thermocoagulation. Palliat Care Res 2010; 5(2): 314-316

Dor posterior baixa e dor pélvica: o que interessa ao proctologista? / Lower back and pelvic pain: what does concern to the proctologist?

Um do mais intrigante e frequente sintoma de doenças agudas ou crônicas é a dor, sobretudo quando aparece sem um substrato anatomo-patológico facilmente identificável, o que dificulta o tratamento e favorece sua persistência. A dor crônica, generalizada ou localizada, transtorna a vida da pessoa, cuja qualidade é significativamente afetada na proporção da intensidade e continuidade da dor. A dor pélvica e a dor posterior baixa são sintomas relativamente comuns, principalmente por estarem relacionados etiologicamente com mais de uma centena de doenças - desde as que são de origem infecciosa até as inflamatórias inespecíficas, passando pelas que são decorrentes de alterações osteomusculares carências ou funcionais, até às neoplásicas eàs de causas indeterminadas. Além disso, há fatores estruturais sobrecarregados pelos atuais estilos de vida, não só em relaçãoà postura física, como permanecer sentado por longo período de tempo, mas também por falta de exercícios que deveriam ser praticados como preparo para o cotidiano. Soma-se, ainda, a estimativa de que 60 por cento das pessoas estão na faixa do sobrepeso e 25 por cento são obesas. Pela frequência de aparecimento e por sua relação com os órgãos pélvicos, a dor pélvica e a dor posterior baixa, cuja investigação pode envolver profissionais de várias áreas, devem ser do obrigatório interesse do médico coloproctologista.

Pain is one the most intriguing and frequent symptom of diseases, above all when it appears without an easily identifiable anatomic pathological substratum. Widespread or located chronic pain upsets the person's life whose quality is significantly affected. Chronic pelvic pain syndrome is a conundrum that may be only partly explained; it is relatively common and etiologically related with more than a hundred diseases (infectious and/or inflammatory) perceived in structures related to the pelvis. "Add to that a general lack of exercise, poor diet, and an overall increase in peoples' weight. With 61 percent of the population overweight (and 27 percent of that group diagnosed as clinically obese), it should be no surprise that this degree of increased weight causes more stress and strain on the pelvis and those articulations that we use when standing, walking, and running.1 Patients also expose themselves to a variety of traumas that often do not heal properly, leading to osteoarthritis, fibrotic joint capsules, and myofascial trigger points."13 For the emergence frequency and for its relationship with the pelvic organs, the pelvic pain and the low back pain can be considered a multifaceted problem, with investigation requiring a multidisciplinary approach involving professionals of several areas, so they should be of the obligatory interest of the proctologist.

Acute Anal Pain due to Ingested Bone Fragments

Impacted bone fragment in the anal canal must not be overlooked as an unusual cause of acute anal pain. Eight cases of acute anal pain arising from impaction of ingested bone fragment within the anal canal were treated over a 4-year period. The eight cases were similar in presentation and outcome. There were six males and two females (age 45~65 years). Seven patients presented within a day of the sudden onset of severe anal pain, and one patient presented with obscure anal pain of three days. In two patients, this pain was aggravated by attempts to defecate. Inspection showed mild to marked spasm of the anal sphincter with no obvious cause for the anal pain. Digital rectal examination revealed spiculated bony fragments impacted in the anal canal at the dentate line in seven cases, and at the anorectal junction in one case. In one case, a fish bone was found penetrating into a hemorrhoid, causing edema and prolapse. In another case, a tiny fish bone was found impacting in a nylon seton applied to a fistulotomy wound. In a third case, a linear fish bone was found penetrating into an anal papilla. Six fish bones and one chicken bone were removed using forceps under proctoscopy. One fish bone was removed at the time of digital rectal examination. Sigmoidoscopy was then performed to assess anorectal injury. Pain relief was immediate, and no sequelae were noted on review at 6 weeks. In all cases, the diagnosis was readily made on simple digital rectal examination, and early removal of the bone fragment resulted in immediate pain relief without complications. Eight cases of acute anal pain due to impaction of ingested bone fragment in the anal canal are reported, and the related literature is reviewed.

Stereotactic Neurotomy of the Ganglion Impar through the Sacrococcygeal Junction in Cancer-Related Perianal Pain: A case report / 대한통증학회지

The ganglion impar is a solitary retroperitoneal structure at the caudal end of the paravertebral sympathetic chain. Block of this ganglion has been advocated as a means of managing intractable perineal pain. In 1990, Plancarte et al performed a neurolytic block of the ganglion impar using 4-6 ml of 10% phenol through the intergluteal skin over the anococcygeal ligament. However, technical difficulties are encountered with the placement of the needle while performing this technique, with complications from the injection of phenol also being a possibility. In 1995, a modified approach for blocking the ganglion impar through the sacrococcygeal ligament was introduced by Wemm and Saberski. We used a radiofrequency (RF) lesion generator to create a controlled and localized lesion with a lower incidence of neural damages compared to chemical neurolysis. RF thermocoagulation of the ganglion impar through the sacrococcygeal ligament was performed on a 70-year-old male patient with constant anal pain using a curved TEW electrode. The patient has been relieved of his pain, without serious complication. Therefore, this technique may be an easier and safer approach, which is associated with fewer chances of complications.

Identification of Patients More Susceptible to Severe Anal Pain after Colonoscopy and Effect of Topical Treatment of Lidocaine Gel in Reducing the Anal Pain: A Prospective, Randomized, Controlled Study (Identification and Management of Patients Susceptibl / 대한소화기내시경학회지

BACKGROUND/AIMS: The aim of this study was to identify which patients are more susceptible to severe anal pain after colonoscopy and to determine the usefulness of lidocaine gel in reducing the anal pain. METHODS: A prospective trial was performed with 150 consecutive outpatients who underwent a colonoscopic examination. The patients were randomized into three groups: they received topical treatment of lidocaine gel (n=48) or lubricant gel (chlorhexidine gluconate) (n=48), or no treatment (n=54) just after the procedure. Data regarding the procedures were collected and the patients were phone-interviewed on the next day. RESULTS: Seventy of 150 (46.7%) had moderate to severe pain (VAS score>or=4). A multiple regression analysis found that the presence of hemorrhoid was significantly (p<0.05) associated with severe anal pain after colonoscopy. Among three groups, there was no significant difference of the pain scores on the procedure day on the next day. However, patients' subjective evaluation about the usefulness of the gel was significantly better in the lidocaine group than in the placebo group in patients who had moderate to severe pain (79.2% vs. 43.5%, p<0.05). CONCLUSIONS: A palliative management is more required for patients who complain moderate to severe pain just after colonoscopy or those with hemorrhoid