Anal Fissure

Question 1

Anal fissure

Answer 1

longitudinal tear in anoderm (squamous lining) of the distal anal canal

Question 2

Risk factors for anal fissures

Answer 2

• constipation
• IBD
• sexually transmitted infections (HIV, syphillis)

Question 3

Clinical features of anal fissures

Answer 3

• < 6 weeks = acute
• > 6 weeks = chronic
• painful, bright red rectal bleeding
• 90% on posterior midline

Question 4

Management of acute anal fissure

Answer 4

1. soften stool (increase fibre, bulk-forming laxative)
2. lubricants (e.g. vasoline)
3. topical anaesthetics
4. general analgesia

Question 5

Example of bulk-forming laxative

Answer 5

isphagia husk

Question 6

Management of chronic anal fissure

Answer 6

• continue acute measures
• topical GTN
• not improved in 8 weeks, refer for sphincterotomy (surgery)