Anal Fissure

Question 1

What are anal fissures?

Answer 1

Longitudinal or elliptical tears of the squamous lining of the distal anal canal.

Question 2

What defines an acute anal fissure?

Answer 2

If present for less than 6 weeks.

Question 3

What defines a chronic anal fissure?

Answer 3

If present for more than 6 weeks.

Question 4

What are some risk factors for anal fissures?

Answer 4

• Constipation
• Inflammatory bowel disease
• Sexually transmitted infections (e.g., HIV, syphilis, herpes)

Question 5

What are the common features of anal fissures?

Answer 5

• Painful, bright red rectal bleeding
• Around 90% occur on the posterior midline
• Alternative locations may indicate underlying causes (e.g., Crohn’s disease)

Question 6

What is the first-line management for an acute anal fissure?

Answer 6

• Soften stool
• High-fibre diet with high fluid intake
• Bulk-forming laxatives
• Lubricants (e.g., petroleum jelly)
• Topical anaesthetics
• Analgesia

Question 7

What is the first-line treatment for a chronic anal fissure?

Answer 7

Topical glyceryl trinitrate (GTN).

Question 8

What should be considered if topical GTN is not effective after 8 weeks for a chronic anal fissure?

Answer 8

Secondary care referral for surgery (sphincterotomy) or botulinum toxin.

Question 9

Fill in the blank: Around 90% of anal fissures occur on the _______.

Answer 9

posterior midline.

Question 10

True or False: Anal fissures can only occur in the posterior midline of the anal canal.

Answer 10

False.