| Condition | History | Symptoms | External exam | Digital exam | Anoscopy |
| Proctitis | - History of receptive anal intercourse
- Prior sexually transmitted diseases
- Prior inflammatory bowel disease
| - Rectal pain, bleeding, and/or purulent discharge
| - Usually normal; discharge may be visible
| | - Inflamed or friable mucosa
- Presence of ulcers may suggest LGV, HSV infection, or syphilis
|
| Perianal abscess/anal fistula | - Prior perianal abscess or anal fistula
| - Rectal pain, bleeding, and/or purulent discharge
- May be associated with fever/chills
| - Usually normal; discharge or fistula tract may be visible
| - Diffuse tenderness
- Submucosal fullness with perianal abscess
| - May show pustule, fistula tract and/or discharge
|
| Anal warts/dysplasia | - Prior anogenital HPV infection (eg, warts, dysplasia)
| | - May show skin-colored papular lesions (warts)
| | - May show mucosal white papular lesions (warts)
|
| Anal cancer | - Prior anogenital HPV infection (eg, warts, dysplasia)
| - Rectal bleeding and/or pain
- Stool caliber may be reduced
| | - Lack of tenderness
- Submucosal fullness
| |
| Anal fissure | - History of receptive anal intercourse
- History of chronic constipation
- Prior anal fissure(s)
| - Intense pain, especially with defecation, and intermittent bleeding
| - Usually normal; bleeding may be visible
| | |
| Hemorrhoids | | - Recurrent rectal bleeding, especially with defecation
- Pain with thrombosed hemorrhoids
| - Dilated vein(s) may be visible
- Tenderness with thrombosed hemorrhoids
| | - Dilated vein(s) may be visible
|
| Pruritus ani | - Prior episodes of pruritus ani
| | - Inflamed skin
- May be evidence of cause (eg, pinworm, dermatitis) in small percentage of cases
| | |
