Anal fissure

Question 1

Define anal fissure

Answer 1

Painful tear in the squamous lining of the lower anal canal

Question 2

Locations of anal fissures

percentages

Answer 2

90% are posterior

Anterior fissures tend to occur after childbirth

Question 3

Aetiology of anal fissures

3

Answer 3

Most caused by hard faeces
Anal sphincter spasm can constrict inferior rectal artery, causing ischaemia & impairing the healing process

Rare causes - syphilis, herpes, trauma, Crohn’s, anal cancer, psoriasis

Question 4

Epidemiology of anal fissures

prevalence, gender, age

Answer 4

Affects 1/10 in lifetime
Both sexes affected equally
Can occur ate any age, but mostly in children & young adults: 10-30yrs

Question 5

Presenting symptoms of anal fissures

3

Answer 5

Tearing pain when passing stools
May be some blood in faeces or on paper
Anal itching (pruritus ani)

Question 6

Signs of anal fissures on physical examination

Answer 6

Tears in squamous lining of anus on examination

Question 7

Investigations for anal fissures

Answer 7

Examine anus

Question 8

Management of anal fissure

3

Answer 8

Conservative
Medical
Surgical

Question 9

Management of anal fissure - conservative

3

Answer 9

High fibre diet
Softening stools (laxatives)
Good hydration

Question 10

Management of anal fissure - medical

4

Answer 10

Lidocaine ointment (LA)
GTN ointment
Diltiazem
Botulinum toxin injection

Question 11

Management of anal fissure - surgical

2

Answer 11

Lateral sphincterotomy
Relaxes anal sphincter & promotes healing but complications (anal incontinence) mean its reserved for those intolerant/unresponsive to non surgical treatments

Question 12

Complications of anal fissure

Answer 12

Chronic anal fissure

Question 13

Prognosis of anal fissure

2

Answer 13

Fissure will heal in about a week for most people

Treatment about easing pain by keeping stools soft & relaxing anal sphincter to promote healing