Anorectal Conditions & Stoma Care
Assess pain and bleeding respectfully, identify anorectal sepsis and recognise stoma complications early.
Quick revision ↓ Medical Dictionary
01Take a focused history
Clarify pain in relation to defaecation, bleeding pattern, discharge, continence and bowel habit. Ask about weight loss, immune status, inflammatory bowel disease and previous procedures. Explain the examination, obtain consent and offer an appropriate chaperone. Severe pain may limit bedside examination and require a different supervised approach. Do not force an examination that is unsafe or intolerable simply to complete a routine sequence.
02Differentiate common conditions
A fissure often causes sharp defaecation-related pain with small-volume bleeding. Haemorrhoids may cause bleeding or prolapse but do not explain all rectal symptoms. Constant severe pain, swelling or systemic illness raises concern for abscess. A fistula can cause recurrent discharge, often following previous sepsis. Atypical, recurrent or complex disease requires assessment for underlying pathology rather than repeated symptomatic treatment alone.
03Treat anorectal sepsis
An abscess generally requires timely surgical drainage assessment, with antibiotics added according to systemic illness, immune status and local guidance. Deep collections can have little visible external swelling. Delay can worsen pain and infection. Fournier gangrene or rapidly progressive perineal infection is a surgical emergency; severe pain and systemic toxicity should prompt immediate escalation even when early skin changes are limited.
04Assess a new stoma
Observe colour, viability, swelling, mucocutaneous junction, output and surrounding skin. Some postoperative oedema is expected, but a dusky or black stoma, worsening pain or absent output with obstructive symptoms needs urgent review. Record fluid losses carefully, particularly from an ileostomy. Stoma-care specialists help with appliance fit, skin protection and education that enables confident self-care.
05Recognise high-output and late problems
High output can cause water, sodium and magnesium depletion with kidney injury. Assess intake, medications, infection and obstruction-related causes, then use a specialist fluid and nutrition plan rather than simply advising unrestricted plain water. Retraction, prolapse and parastomal hernia need assessment according to symptoms and viability. Explain warning signs and ensure the patient knows whom to contact after discharge.
High-Yield Revision
- Deep anorectal abscesses may have few external signs.
- Stoma colour and output require active review.
- High-output ileostomy can cause significant dehydration and kidney injury.
Common Pitfalls
- Do not assume haemorrhoids explain every episode of rectal bleeding.
- Do not manage a threatened stoma solely by changing the appliance.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.