ABSTRACT
Many patients present to the surgeon with anal symptoms. Discomfort, ranging from itching to severe pain, is common and may be associated with anal bleeding or minor prolapsing. More major problems include full-thickness prolapse, defaecatory difficulties and impaired continence. All patients require careful assessment to exclude serious pathology. Most, however, will be found to have minor anal pathology, the majority of which will require no surgery. Many patients only require reassurance that the symptoms are not caused by cancer. Others have troublesome symptoms related to haemorrhoids or fissures but medical treatment, or a minor procedure which can be undertaken in the outpatient clinic, may be all that is required. Many with defaecatory problems, or impaired continence, will require careful assessment of their problem, but only a minority will be helped by surgery.
An understanding of the anatomy and physiology of the anal canal is of major importance to any surgeon undertaking even the most minor anal operation, as stretching of the sphincter muscles or partial division, whether inadvertently or in the treatment of a fissure or fistulae, may have a deleterious effect on continence.
