Cryptitis is a localized infection of one of the anal glands. This unusual condition is identified anoscopically as a pearl of pus beading up from the crypt at the level of the dentate line. Treatment is obliteration of the gland, which necessarily involves an internal sphincterotomy. Fistulae and abscesses can develop with untreated prolonged infection.
Anal crypts are tiny recesses of epithelium at the upper end of the anal canal at the mucocutaneous junction. They are tiny mucus glands of lubrication arranged in a circle around the upper end of the anal canal. Located between normal structures called anal papillae, crypts are usually small, but visible enough to help give the pectinate line a serrated appearance on anoscopy.
Crypts are normal structures causing no symptoms unless they become inflamed. They are small areas of skin situated between the anal papillae. They are approximately 3 mm in depth and are lined with a single layer of epithelium, which is a continuation of the skin of the anus. Just before a bowel movement, the sphincter muscles contract and squeeze out a little drop of lubricating mucus from each of these crypts, aiding in the normal slippery passage of stool.
Cryptitis is defined as an inflammatory process in the crypts, characterized by redness, swelling, and thickening of the tissues in this area. This condition is identified proctoscopically as a pearl of pus beading up from the crypt at the level of the dentate line. Cryptic infection often causes the dissolution of the roof of the crypt, resulting in anal fissure. An infected crypt that is chronic, and fails to un-roof, can develop into an anal abscess and/or fistula.
Cryptitis is held responsible for a variety of conditions and symptoms. The pain of cryptitis is usually of the sharp lancinating or burning variety. A dull ache, or intense pain from spasm of the contraction of the sphincter muscle may develop from the inflammatory process. The nature of a crypt infection is of an ebb and flow, and may be of such a low grade that the pain is transitory.
The cause of cryptitis may be due to an inflammatory process in the adjacent areas, or a disturbance in the acid ph balance of the rectum. Trauma from constipated stools, infections introduced from external sources, parasites, foreign debris, etc., may also initiate cryptitis.
Surgical removal of a crypt is not the complete answer to treating cryptitis. The cause must be eliminated.
Most often, an abscess becomes a painful, compressible mass that is red, warm to touch, and tender.