4/25/2024 0 Comments Photos of spots around my bum holeHe was not keen on the idea, and insisted on a second opinion, which came to the same conclusion. The only treatment that seemed to help was the use of an anal plug. He was referred for investigation but no obvious cause was found. Causes such as diet and medication were excluded. ![]() It is worth taking a swab to ensure there is no streptococcal infection.Īn 80-year-old man was very distressed by the problem of persistent faecal leakage. A steroid cream of moderate potency is often required to control the condition initially, along with a soap substitute. The patient should avoid using products containing perfumes and, ideally, wear loose-fitting cotton underwear. It can be a very difficult condition to control. The patient may have a history of eczema elsewhere, but this is often not the case. It has usually been there for some time as patients are reluctant to present. ![]() This condition usually presents with the complaint of irritation. This was not an option that the patient wanted and as the pain was manageable, he decided to wait and see. In the past, these were incised in the surgery and immediate relief was provided. It had already leaked a little blood, reducing the level of acute pain. Examination revealed this thrombosed external pile. In this case, the classical presentation was of a new and acutely painful swelling. He eventually had a formal haemorrhoidectomy. He was treated with injection sclerotherapy but had further problems in the following months. He was referred and sigmoidoscopy confirmed the presence of internal and external haemorrhoids. He had recently become aware of a new swelling. This elderly man was worried as he had a history of occasional bright red rectal bleeding which he had managed with OTC topical agents. Piles are probably the most common perianal problem that we see in general practice. The advice given was to avoid any possible irritants and use a combination cream with a topical steroid and antifungal. ![]() To make the diagnosis even more difficult, he had spent some time applying a wide range of OTC creams to the area. He complained of longstanding irritation. This 40-year-old diabetic man had no obvious history of psoriasis anywhere else on his body. Psoriasis can be a very difficult condition to diagnose. Occasionally, fissures may be associated with an underlying problem such as inflammatory bowel disease. Advice about straining and diet, along with use of topical agents such as nitrates and stool softeners, usually results in healing. It usually results from overstretching of the anus, and presents with pain on defecation often associated with a small amount of fresh red bleeding, usually noted on the paper. ![]() This is a painful tear in the perianal skin. The cause is unknown, but patients often have more than one lesion, and as in this case, they can become quite large. Histology confirmed the benign nature of the lesion. He was referred and it was removed easily. It had been present for some years, but his new partner did not like it, making him seek help. This man rather sheepishly requested help with the removal of this perianal lesion. Following drainage, the abscess cavity required regular dressing but healed well. There was no obvious underlying cause, such as inflammatory bowel disease or diabetes. It clearly needed incision so he was admitted for this to be done under general anaesthetic. There was a large abscess which was easily palpable with surrounding cellulitis. This 40-year-old man presented with a very painful infection.
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