Anal Fissure

Question 1

What is the definition?

Answer 1

Split in the anoderm distal to the dentate line

Question 2

Etiology?

Answer 2

Trauma(passage of hard stools)

Question 3

Clinical Presentation

Answer 3

• T earing pain with defecation
• Severe anal spasm that last for hours after bowel movement
• Hematochezia (bright PR bleed on toilet paper or on surface of stool)
• Perianal pruritus and/or skin irritation
• Chronic anal fissure = symptoms lasting for more than 6-8 weeks

Question 4

Physical Exam

Answer 4

• Acute: superficial tear (usually posteriorly) – if lateral (consider secondary causes ▪ Patients often unable to tolerate DRE / Anal Speculum
• Chronic: hypertrophied with skin tags and/or papillae (4 signs, not related to duration)
  ▪ Hypertrophic anal papilla (at proximal end, near the dentate line)
  ▪ Boat shaped – heaped up edges
  ▪ Exposing muscle internal sphincter
  ▪ Sentinel skin tag (at distal end of fissure)

Question 5

Causes of 2’ anal fissure

Answer 5

• Crohn’s Disease (fissure in lateral position)
• Extra-pulmonary TB
• Anal Squamous Cell Cancer
• Anorectal Fistula
• Infections – CMV, HSV, HIV, chlamydia and syphilis

Question 6

Management of anal fissures

Answer 6