Anal Fissure

Question 1

Etiology and Pathogenesis

Answer 1

-A.F occurs as a result of mechanical injury of m.membrane of anal canal imncase of constipation or diarrhea

-Predisposing diseases are;
-proctitis
-colitis
-hemorrhoids
In women fissures can form during delivery

-In the Pathogenesis the neuro-reflex theory is mentioned according to which spasm of the sphincter appears as a result of an evident pain syndrome, it causes tissue ischemia and hinders regenerative processes of the fissure

Question 2

Clinical presentation of Anal fissure

Answer 2

The triad of symptoms

• intensive pain during defeacation
• moderate hemorrhages in the form of blood stria on feces and
• spasm of the anal sphincter

Patients have fear to defecate which results in a vicious circle which aggravates the course of the disease

Question 3

Diagnosis of Anal Fissure

Answer 3

• anal examination-fissure is seen on one of the walls of the anal canal
• Digital rectal exam and fibrisigmoidoscopy are done after introduction of 5-10ml of 1-2% Novocain solution infer the fissure or after sprinkling an anesthetic aerosol

Acute fissure has a linear or slit-like shape, soft, even boarders
Chronic fissure- has dense callous borders, excrescences of granulation tissue occurs . They are called sentinel piles

Differential diagnosis-
-thrombophlebitis of hemorrhoids,coccygodynia, Chrons disease, ulcer-cancer , specific ulcers of the anal canal (syphillis, TB)

Question 4

Treatment of Anal Fissure

Answer 4

It is conservative
Aim is to;
-control of pain
-elimination of anal sphincter fissure
-elimination of constipation
Patients should eat veggies,sour milk diets,
In the presence of chronic fissure surgical treatment is used
The aim of operation is excision of the fissure with its base, cicatrical borders and sentinel piles

In the presence of anal sphincter spasm the operation finished with dosated sphincterotomy and the wound is kept open
Concomitant diseases of the GIT must be treated

Prognosis of the disease is good