Anal fissure Flashcards
What is an anal fissure?
Split in skin of distal anal canal, characterised by pain on defecation and rectal bleeding.
Pain described as “like passing broken glass”/ burning and may continue for 1-2h
Small amount of fresh blood often passed in stool
Risk factors for anal fissures?
Pregnancy (second commonest GIT complication of pregnancy after haemorrhoids)
Epidemiology of anal fissures?
Most common in young/ middle-aged adults
Examination signs for anal fissure?
Spasm of sphincter muscles, w significant tenderness often precluding DRE
Aetiology of anal fissures?
- Common precipitant: passage of hard stool
- Spontaneous
- Opiate analgesia assoc w constipation and subsequent increased incidence of anal fissure
Risk factors for anal fissure?
- Hard stool
- Pregnancy
- Opiate analgesia
Signs and symptoms of anal fissure?
- Pain on defacation
- Fresh blood in stool
- Anal spasm
- Symptoms are intermittent
- Sentinel pile
What is a sentinel pile?
Generally harmlessgrowths that hang off skin around outside of anus. Uncommon symptom of anal fissure
Main investigation for anal fissure?
Clinical diagnosis
Potential investigation for anal fissure? (Uncommon, 2)
Anal manometry: if resistant fissures
- Result: low resting pressure
Anal ultrasound: if suspected anal sphincter deficits
- Result: defects in external/ internal anal sphincter
Initial treatment of anal fissures?
Conservative: high-fibre diet, increased fluid intake; in more severe cases, stool softeners and analgesia
Consider topical nitrates/ calcium channel blockers/ diltiazem
Treatment for resistant anal fissures?
- Botulinum toxin injection (if topical treatment fails)
- Surgical sphincterotomy
