Benign Perianal Disease

Diagnosis/Definition

• Fissure-in-ano: a tear of the skin-lined part of the anal canal.
• Fistula-in-ano: an inflammatory track with an external opening in the perianal skin and an internal opening in the anal canal near the dentate line. * They are often associated with a perianal or perirectal abscess.
• Pilonidal disease: an inflammatory cyst or sinus in the midline overlying the sacrococcygeal region.

Initial Diagnosis and Management

• They usually present with perianal pain.
• Physical exam will show an abscess if present.
• A fissure may be difficult to see, but also presents with streaks of blood on the stool and pain with defecation.

Ongoing Management and Objectives

Fissures can be treated with stool softeners, analgesics and sitz baths.

Indications for Specialty Care Referral

All patients with pilonidal disease or fistula-in-ano (with or without an abscess) should be referred to General Surgery. If a fissure-in-ano persists despite a month of soft stools the patient should be referred to General Surgery.

Criteria for Return to Primary Care

These patients will be followed in General Surgery while experiencing active disease and for approximately one month after surgical therapy.