Anal fissure

Question 1

What is an anal fissure?

1 - tear in anal columns of anal canal
2 - prolapse of anal column
3 - anal abscess
4 - longitudinal tear in anal mucosa

Answer 1

4 - longitudinal tear in anal mucosa

Question 2

An anal fissure is a tear in anal mucosa. Are acute or chronic tears more common?

Answer 2

• acute anal fissures
• equally as common in male and female and can affect all ages

Question 3

Anal fissures are often associated with other pathology. Which of the following is NOT one of the 3 most common pathologies associated with anal fissures?

1 - IBD
2 - fistula
3 - IBS
4 - cancer

Answer 3

3 - IBS

Question 4

Anal fissures can cause severe pain that can last for long periods, made worse during defaecation. In addition to pain, which of the following is the most common presenting symptom?

1 - PR bleed
2 - GI bloating
3 - haemorrhoids
4 - anal fistula

Answer 4

1 - PR bleed

• fissures are normally present at anal verge

Question 5

In a patient with anal fissures what is the one thing patients are told to try and avoid?

1 - high fat foods
2 - high fibre diet
3 - diarrhoea
4 - constipation

Answer 5

4 - constipation

Question 6

Which of the 2 following medications can be given as creams to help treat anal fissures?

1 - diltiazem
2 - glyceryl trinitrate (GTN)
3 - bisoprolol
4 - ramipril

Answer 6

1 - diltiazem
2 - glyceryl trinitrate (GTN)

• both vasodilate
• effective over 6 weeks and 50-60% effective

Question 7

Which of the following treatments has a 60-80% effectiveness?

1 - diltiazem and GTN
2 - botox into internal sphincter
3 - rest
4 - lateral sphincterotomy

Answer 7

2 - botox into internal sphincter

Question 8

Lateral sphincterotomy can be performed surgically if there are not other treatment options for patients. What is the major risk factor for this form of treatment?

1 - PR bleed
2 - diarrhoea
3 - long term continence
4 - herniation

Answer 8

3 - long term continence

• 10-15% risk