Perianal Problems
Assumptions
The student knows the basic anatomy of the anal canal and rectum and is familiar with the basics of the
mechanism of defecation.
Objectives
1. Develop a differential diagnosis for a patient with perianal pain. (Be sure to include benign, malignant
and inflammatory causes.)
2. Discuss the characteristic history findings for each of the above including:
 character and duration of complaint
 presence or absence of associated bleeding
 relationship of complaint to defecation
3. Describe physical exam findings for each diagnosis. Indicate in which part of exam (external, digital,
anoscopic or proctoscopic) these findings are identified.
4. Discuss treatment plan for each diagnosis listed in objective one, including non-operative interventions
and role and timing of surgical interventions.
Problem
A 25-year-old man presents with the sudden onset of perianal pain.
 list specific questions to be included in the history
 discuss how your differential might change if the patient has AIDS
 discuss how your differential might change if the patient is 62 with a history of a 10 lb weight loss
Prevention
Discuss dietary habits which may help prevent anorectal problems.