Anal Fissure Flashcards
What are anal fissures?
Painful longitudinal tears in the anal mucosa under the dentate line
Anal fissures can be classified as typical or atypical based on their causes.
What is a major risk factor for developing anal fissures?
Chronic constipation
This condition can lead to increased straining during bowel movements.
What are the two types of anal fissures?
- Typical/Primary Fissures - local trauma
- Atypical/Secondary Fissures - associated with a condition e.g. Crohn’s
Primary fissures are usually due to localized injury, while secondary fissures are linked to underlying diseases.
What are common symptoms of anal fissures?
- Severe anal pain (present at rest but worse on defecation)
- Anal bleeding/hematochezia
- Local trauma in primary fissures
- Chronic, multiple, and non-healing fissures in secondary fissures
Symptoms can vary based on the type of fissure.
Where are primary anal fissures commonly located?
Commonly in the POSTERIOR Midline
They can also be found in the anterior or both locations.
What are the signs of secondary anal fissures?
Often in lateral region + may have Perianal skin tags
This indicates a more complex underlying issue.
What is the management for acute typical anal fissures?
- Stool softeners - high fibre + high fluid
- Bulk forming laxatives
- Analgesia + anaesthetics topical analgesics
These treatments aim to relieve symptoms and promote healing.
What treatment is recommended for chronic anal fissures?
- Topical GTN/diltiazem to help relax smooth muscles and promote healing (takes 8 weeks to work)
- Surgery - Botulinum toxin injection or sphincterotomy
Chronic fissures may require more intensive management.
What is the first line of management for atypical anal fissures?
- Supportive care
- Colonoscopy for patients 50+ or with family history of colon cancer
- Sigmoidoscopy for all other patients
- Treat underlying cause e.g. Crohn’s disease
Atypical fissures often require investigation for associated conditions.
What is the second line of treatment for atypical anal fissures?
- Surgical consult
- Inject botulinum toxin
- Lateral internal sphincterotomy
- Anal advancement flap
These procedures aim to address more complex or resistant fissures.
What anatomical distinction is made above and below the dentate line?
Above dentate line = hindgut (visceral)
Below dentate line = skin (very painful)
This distinction is important for understanding pain perception in anal fissures.
