Anal fissure Flashcards
What is an anal fissure?
Small tears or cuts in the lining of the anal canal
What are the causes of anal fissure?
Primary or idiopathic
- Associated with chronic constipation and straining
Secondary
- IBD
- Malignancy
- Trauma
- STIs
What are the risk factors for anal fissures?
Chronic constipation
Straining during bowel movements
Persistent diarrhoea
Passing hard or large stool
Anal sex
IBD
Pregnancy and childbirth
What are the features of an anal fissure?
Severe pain during and after bowel movements
Bright red blood on toilet paper
Itching
Visible tear in lining of anus
Tenderness on rectal exam
What is the first line management of an anal fissure?
Dietary advice - high fibre diet
Bulk forming laxatives e.g ispaghula husk
GTN ointment - relaxes anal sphincter and reduced pressure on fissure
Topical anaesthetics
What is the second line management of anal fissure?
Laternal internal sphincterotomy - for fissures that don’t respond to conservative management
