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The Medical Post

BY MARA GULENS

TORONTO - Anusitis is the frequently missed anal diahnosis "hands down" said Dr. Bill Rudd, director of the Rudd Clinic in Toronto.

IHis evidence is based on a series of patients diagnosed by physicians as having hemorroids, who actually have anusitis, an inflammation of the anal canal quite distinct from irritation of the rectum and extrenal skin.

The anal canal is a very short 3cm long collapsed structure that doesn't bold suppositiores, which go up into the rectal ampulla, or cream, which goes into the skin. Since the area changes from columnar to squamous epithellum, the buring pain is felt only distal, not proximal to the dentate line.

Pruritus ani, which is almost always caused by an impreceptible discharge to the outside, also indicates anusitis. Diagnosis of anusitis "is very very simple and yet it's being missed so much," said Dr. Rudd.

The circumferentail lesion involes no sweling or prolapse, and "when anybody has bleeding the think it's automatically hemorrhoids. Not true," said Dr. Rudd at the recent Rudd Clinic Seminar. When the buttock's are separated there is no extremal pain or evidence of peri-anal swelling or fissures. However, digital examination reveals a circumferentail pain that is "absolutely charactecriste," he said.

Anusopes or sigmoisoscopes used to examine the rectal ampulla must be withdrawn slowly, since anusuitis is often missed when the instrument is "yankod out" too quickly. "Unless you really make an effort to make it come out trought the anal canal very, very slowly, you're going to miss it every time," said Dr. Rudd.

Food and drin are "far and away the most common causes" of anusitis, followed by antibiotics, tension, smoking and food allergies, said Dr. Rudd. Long-term teratment means no coffee, beer colas and garlic, as well as elimination of diarrhea and stress. However, immediate results can be attained with cryotherapy.

To soothe the muoosa of the anal canal. Anurex, a reusable probe files with a cold gel, is placed in the freezer of the refrigerator for at least an hour before use, the probe is then inserted into the anus for six minutes. The probe can be used as often as needed, but at least twice a day while three is pain, and once daily when tha pain decreases. Treatment should be continued for one week following relief and parients prone to anusitis should use it before and after, for example, "a night of boozing." he said.

After a petient told Dr. Rudd that crushed ice in a condom had cured his anusitis, it took him another nine months and 220 ceesecutive patients to be convidence Anurex really works. The initial improvement rate was 93% and a further single-blind study also showed its effecacy. Dr. Rudd said vascontriction decreates the blood flow and edema fluis, but possibly also alters the pH level in the bacterial flora of the anal canal.

The probe is resable for six months at which time the cold retaining get breaks down an becomes less effective. It is nondegradable, does not involve chemicials or steroids and is thus safe during pregnancy.

The only problem maybe motivating pateints to apply something cold, but "it's not something you have to be afraid of, because ice is something that's been used for hundreds of years quite effectively," Dr. Rudd told the audience.


TOTONTO- Anal stenois is casy to miss, but very casy to diagnose and even easier to treat. "Folloeing anusitis, anal stenosis is the second most commonly missed anal problem," said Dr. Paul Byrne at a recent Rudd Clinic Seminar here. Primary anal stenosis is caused by an inclasic band of scar tissue located near the trip of the internal sphineter.

Diagnosis is made on the basis of history and can resemble other types of anal lesions," but the patients virtually always talk about the fact that they have narrow canal, said Dr. Byrne.

Examination is made by seporaling the buttocks, chocking for scar tissue and doing a digital examination. Diagnosis is bassed on bidigital examination to feel for the band of scar tissue. Dr. Byrne said anal stencis many occur seccedury to sphincer spasm pruritus and recurrent 'fissures, and can occur in individalus who don't eat enough fibre and have repeated small bowel moversent. However the vast majority occurs secondary to surgery for cither hemorrhoids of fissures.

According to Dr. Byrne, a colon and rectal surgeon at the Rudd Clinic in Toronto, conservative treatment "virtually never works," and of available surgical treatments the simples and most effective is the so-called Rudd Clinic anoplasty which requires minimal instrumentation and is usually done in the office.

With the index finger in the anal canal, local anesthetie is introduced on the sides of either buttock. A radial inition is made and artery forceps used to separate the skin from subcutanous tissue, while the fibrous band is separated from the sphineter.

The band is streatched with two fingers in the anal canal and grasped between two astery forceps and dividod. Finger pressure applied to the anal canal for two to three minutes coetrols bleeding. The procedure is repeaded on the other buttock to ensure the band is completly divided. Two fingers placed in the anal canal control bleeding and a cotton ball placed between the buttocks acts as the nocessary dressing. Folkwing anoplasty, patients are taught to use a dilator.

Dr. Byrne said 94 of 103 patients received good to excellent results with anoplasty, while 6% had some improvement and 3% were not helped by the procedure. The procedure was efficacious in 97% of patients. According to Dr. Bill Rudd, director of the Rudd Clinic, mere dilation should not be undertaken to treat anal stenosis. "Forced anal dilation-don't do it," he said.

Since anal stenosis is caused by a ring of scar tissue it should be surgically removed so as not to stretch normal structures and cause innontinence and damage to the internal sphincter. "

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National Enquirer - May 1994


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