The Diagnosis and Management of Common Anorectal Disorders*

ne of the things that distinguishes surgeons who are comfortable and ompetent in the management of anorectal disease from others is their pproach to the patient. Such an approach ideally should put the patient at ase and reduce the fear and embarrassment that are often associated, in the atient’s mind, with seeking care for anorectal problems. The process starts hen the patient calls to make an appointment, and they are usually relieved hen the self-diagnosis of “hemorrhoids” is accepted without question by the cheduling staff. When the patient first meets the physician, this is best done n a nonthreatening environment, which can be either a consultation room or n examining room that has a comfortable chair for the physician and patient, writing desk, and examining instruments out of sight. Once the interview as been completed, the patient can then be directed to the examining table, ither by the physician or by an assistant. It is our practice to examine patients while they are lying in the left ateral decubitus position. This has a number of advantages, not the least f which is that it is much easier on the patient, both physically and motionally. In addition, it does not require expensive and cumbersome procto tables” and allows for storage of instruments and supplies within he side of the table itself, rather than requiring a separate cart or cabinet or these. We start the examination with the patient, fully clothed, lying upine on a standard examining table. Despite the fact that the complaints re anorectal, we examine the abdomen first to be sure there are no bdominal components of the problem, and also because it puts the atient at ease by beginning with a nonpainful, gentle, and often nexpected portion of the examination process. The clothing is loosened nd only the portion being examined at the time is exposed. Once the bdominal examination is completed, the patient is placed on his or her eft side, with the knees drawn up, and the anorectal area is exposed, with