Ulcer of the anus and rectum

Disease Description (Causes and Symptoms)

• Definition: Ulcers of the anus and rectum are a condition in which inflammation and necrosis develop in the mucosa or skin of the anus and rectum, forming a defect (ulcer) accompanied by bleeding, pain, and other symptoms.
• Main causes
  • Mucosal damage caused by excessive pressure during bowel movements or chronic constipation
  • Bacterial infection (bacterial proctitis), progression of a fistula or abscess
  • Anal fissure, fissure, fistula, perianal abscess
  • Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
  • Infectious causes (sexually transmitted infections, viruses, tuberculosis, etc.)
  • Ulcers associated with tumors (rectal cancer, anal cancer)
  • Drug- or radiation-induced injury, trauma (foreign bodies, after surgery)
  • Risk factors: excessive alcohol consumption, extreme dieting (causing constipation), pregnancy (increased venous pressure)
• Pathophysiology (briefly): Repeated mechanical and inflammatory injury destroys the mucosal layer and underlying tissue. If bacteria proliferate in this area, the condition may progress to inflammation, abscess, or fistula.
• Main symptoms
  • Anal pain (especially during bowel movements), a feeling of incomplete evacuation, bleeding after bowel movements (bloody stool), discharge or pus
  • Abdominal pain, diarrhea or constipation, low-grade fever, general malaise, nausea, vomiting, etc.
  • Weight loss and anemia may occur if the condition becomes chronic
• Conditions included in the differential diagnosis: Hemorrhoids, anal fissure, fistula, rectal cancer, inflammatory bowel disease, infectious proctitis, etc.
• Diagnostic approach (summary): Medical history and digital rectal examination, anoscopy/proctoscopy, and, if necessary, biopsy, colonoscopy, rectal ultrasonography, CT/MRI, blood tests, and stool tests

Treatment Methods and Precautions

• Conservative treatment (for mild cases or general treatment of the underlying cause)
  • Correction of constipation: increase dietary fiber intake, drink sufficient fluids, and exercise regularly
  • Stool softeners (if necessary), and sitz baths to relieve pain and promote drainage
  • Local treatment: topical antibiotics and anti-inflammatory drugs (use steroid ointments under a doctor’s instructions)
  • Systemic medications: oral or intravenous antibiotics if infection is suspected; painkillers for severe pain
  • If anemia is present, supplementary treatment such as iron supplements
• Endoscopic/surgical treatment
  • If a biopsy confirms the possibility of malignancy, tumor treatment (surgery, chemotherapy, radiation therapy) is required
  • If an abscess is present or drainage is needed, surgical drainage is performed
  • For refractory, fistulous, or severe ulcers, surgical treatment such as fistulectomy or sphincter-preserving surgery may be considered
  • Emergency surgery is required if complications (perforation, persistent bleeding, peritonitis) occur
• Treatment of specific causes
  • If caused by inflammatory bowel disease, long-term treatment with immunosuppressants, biologic agents, and other medications by an inflammatory bowel disease specialist
  • For specific infections such as tuberculosis or sexually transmitted infections, treatment with the relevant antimicrobial agents
• Precautions for self-care
  • Do not strain excessively during bowel movements. Sitz baths and gentle hygiene after bowel movements are recommended
  • Limit factors that irritate the mucosa, such as alcohol, irritating foods, and spicy foods
  • Follow instructions for taking prescribed medications (especially steroids and antibiotics)
  • Seek emergency medical care immediately in case of severe perianal pain, heavy bleeding, fever, or worsening general condition
• Risk of complications
  • Persistent bleeding and anemia, formation of a fistula, defecation problems due to anal sphincter damage, perforation and peritonitis, systemic spread of infection, and (rarely) malignant transformation or discovery of an underlying tumor

Checklist Before an Outpatient Visit (Including Items to Prepare and Sample Questions)

• Items to prepare (recommended to bring)
  • A list of all medications currently being taken (including prescription drugs, OTC medications, and supplements)
  • Results or summaries of previous tests (endoscopy, CT/MRI, ultrasound)
  • Symptom diary: when symptoms began, frequency, bowel patterns (constipation or diarrhea), number and amount of bleeding episodes, and pain intensity (recorded numerically)
  • Past medical history (especially intestinal disease, surgery, and risk factors related to sexual activity), and whether you are pregnant
  • Body temperature and photographs (of perianal trauma, drainage, discharge, etc., taken while maintaining privacy as much as possible)
• Information to tell the medical staff in advance when visiting
  • High fever, severe pain, heavy bleeding, and whether antibiotics were administered recently
• Items that may be shown to the doctor during the consultation (examples)
  • Results and dates of recent endoscopy/imaging tests
  • Factors that worsen symptoms (meals, medications, exercise, etc.)

Examples of General Questions to Ask the Doctor

• "What is the most likely cause of this ulcer? What additional tests are needed?"
• "What treatment options are recommended, and what are the benefits and risks of each?"
• "What are the side effects of the medications (such as the prescribed antibiotics and steroids), and when should I stop taking them?"
• "What lifestyle change should I make first to prevent recurrence?"
• "How long is the expected healing period? What is the follow-up testing schedule?"

Examples of Condition-Specific Questions

• "What tests should be performed to determine whether this ulcer is related to inflammatory bowel disease (e.g., Crohn’s disease)?"
• "If a fistula or abscess is suspected, when is surgical drainage or surgery recommended, and how will preservation of sphincter function be ensured?"

End.