10. Rectal and anal fissures

Question 1

Anal fissure

Answer 1

A small tear or ulcer in the mucosal lining of the anal canal

Question 2

Anal fissure symptoms

Answer 2

Sharp pain

Bright red blook

Linear split

Question 3

Treatment for acute anal fissure

Answer 3

Constipation is a risk factor as it causes hard stool or straining which can lead to anal tears

To treat anal fissures:
* Treat constipation with a bulk-forming laxative.
Alternatively, osmotic laxative

For pain relief
* simple analgesic
* local anasthetic e.g lidocaine, should only be used for a few days as it can sensitise the skin

Question 4

Treatment for chronic anal fissure

Answer 4

If the anal fissure has lasted for over 6 weeks, this means it is chronic.

Treatment:
GTN rectal ointment (it dilates blood vessels to increase blood supply to the fissure helping it heal faster)

Question 5

Haemorrhoids (piles)

Answer 5

Swellings in the anal canal

Can be internal or external

Question 6

Haemorrhoids symptoms

Answer 6

Swellings

Painful

Itchy

Bleeding - bright red

Question 7

Haemorrhoids treatment

Answer 7

Treat constipation (risk factor for haemorrhoids):
* bulk forming laxative

For pain relief
* Simple analgesics (avoid NSAID as they can worsen bleeding)

Topical treatment
* Local anaesthetic such as lidocaine
* Corticosteroid - but should only be used for max 7 days as they can cause skin thinning with prolonged use