Anal fissure

Question 1

What is an anal fissure?

Answer 1

longitudinal or elliptical tears of the squamous lining of the distal anal canal

Question 2

What time frame separates an acute from a chronic anal fissure

Answer 2

< 6 weeks = acute
> 6 weeks = chronic

Question 3

Risk factors for anal fissure

Answer 3

• constipation
• inflammatory bowel disease
• sexually transmitted infections e.g. HIV, syphilis, herpes

Question 4

At what position do fissures most commonly occur?

Answer 4

around 90% = posterior midline.
(if alternative location then consider Crohn’s disease)

Question 5

How do patients normally present with anal fissures?

Answer 5

painful, bright red, rectal bleeding

Question 6

Management of acute anal fissure

Answer 6

soften stool
- high-fibre diet
- high fluid intake
- laxatives

lubricants before defaecation
topical anaesthetic
analgesia

Question 7

Management of a chronic anal fissure

Answer 7

• topical glyceryl trinitrate (GTN)
• if not effective after 8 weeks then consider surgery (sphincterotomy) or botulinum toxin