Treatment of anal cryptitis, which should be conservative, is based on establishing a definitive diagnosis and ruling out the possibility of more serious anorectal problems. The diagnosis can be suspected clinically from the history and the palpation of the tender, swollen crypt and its associated hypertrophied papillae. Definitive diagnosis of cryptitis is made by anoscopic examination. Gentle insertion of a hooked probe into the crypts brought into view through the anoscope will reveal the involved crypt(s) to be deeper than normal and definitely more tender.
The goal of treatment is to control the trauma of abnormal bowel movements and thus enable the inflammation to subside. Bulk laxatives and additional roughage to the diet to produce formed, soft stools; combined with hot sitz baths they enhance healing by keeping the anus clean and the crypts empty.
Surgical intervention is indicated when the infection has progressed and there is a deep, redundant crypt that will not drain adequately on its own. In these cases, the roof (mucosal surface), as outlined by the passage of a hooked probe, should be infiltrated with local anesthetic and excised. Thus, what had been a deep pocket is converted into an open wound that should heal with proper control of bowel movements and frequent sitz baths.
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