Anal Fissure Flashcards
What is an anal fissure?
split in the skin of the distal anal canal characterised by pain on defecation and rectal bleeding
What is the incidence of anal fissure like?
1 in 350 adults
What are the risk factors for an anal fissure?
- Hard stools
- Pregnancy
- Opiate analgesia
What are the symptoms of an anal fissure?
- Pain on defecation
- Tearing sensation on passing stool
- Fresh blood on stool or on paper
- Anal spasm
What are possible differential diagnosis for anal fissure?
- Crohn’s disease
- Sarcoidosis
- Tuberculosis
- HIV infection
- Lymphoma
- Syphilis
- Anal carcinoma
What 1sr investigations do you do for anal fissure?
- 1st line = CLINICAL DIAGNOSIS
- Features in the history
- Impossible to Examine / DRE !
- Usually EUA’s (examinations under anesthesia)
What investigations may you consider for anal fissure
- Anal manometry
2. Anal ultrasound
What may anal manometry show in anal fissure?
low resting pressure
What may anal ultrasound show in anal fissure?
defects in internal or external anal sphincter
What is the first line treatment for acute anal fissure?
Conservative Management
- High fibre diet
- Adequate fluid intake
- Sitz baths
- Topical analgesia
What else may you consider for acute anal fissue?
- Topical glyceryl nitrate
2. Topical Diltiazem
What is the first line treatment for resistant anal fissures?
1st Line: botulinum toxin injection
1st line: surgical sphincterotomy
What is the 2nd line treatment for resistant anal fissure?
anal advancement flap
What are the possible complications of anal fissures?
- Chronic anal fissure
- Incontinence after surgery
- Recurrence
What is the prognosis of anal fissures like?
- 60% of patients healing of their fissure at 6 to 8 weeks
- 20% will heal after a course of topical diltiazem
- Some of these patients may subsequently relapse; around 30% will require a surgical option
