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However, sinister findings are possible in this group and a high index of suspicion must be maintained.

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When a fissure is confidently diagnosed, an examination can be avoided at the first consultation.

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Antibiotics that cover Gram-negatives and anaerobes e.

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Treatment can be conservative or surgical.

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Rubber-band ligation is ideal for grade 2 and 3 haemorrhoids and generally provides excellent results, with very low morbidity Table 1. Occasionally a low-lying cancer arising from the anus or rectum can cause severe anal pain due to sepsis or sphincter invasion Fig. Rectal prolapse is most commonly seen in elderly women and occasionally in young women, but is rare in men. Pruritus ani refers to itching of the anus. Anal fistulae present a major proctological challenge.

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