Questions to Ask

It is vital to ask about systemic symptoms, including weight loss and fever. These can suggest a systemic disease with anorectal manifestations, such as inflammatory bowel disease (particularly Crohn’s disease).

Recurrence can also indicate an underlying medical condition such as diabetes, carcinoma or immunosuppression (e.g. HIV). Multiple fissures and fistula formation also suggest an underlying systemic cause [4].

Always ask about altered bowel habit and take a sexual history.

Sexually transmitted infections that have anorectal manifestations include chlamydia, herpes, syphilis and condylomata acuminata (anogenital warts) [1-2].

Learning bite

Taking a clear and detailed history and maintaining a high index of suspicion for systemic diseases is important in diagnosing anorectal conditions in the ED.