Anal fissure Flashcards
1
Q
Define anal fissure, summarising its aetiology and epidemiology
A
Definition: A painful tear in the squamous lining of the lower anal canal
NOTE: 90% of anal fissures are posterior (anterior anal fissures tend to occur after
childbirth)
Aetiology:
- Caused by hardened faeces
- Anal sphincter spasm can constrict the inferior rectal artery, causing ischaemia and impairing the healing process
- Rare causes: syphilis, herpes, trauma, Crohn’s, anal cancer, psoriasis
Epidemiology:
- Affects 1/10 people during their life time
- Both sexes are affected equally
- Can occur at any age
- Most cases occur in children and young adults: 10-30 yrs
2
Q
Describe the history/presenting symptoms of anal fissure
A
- Tearing pain when passing stools
- There may be a little bit of blood in the faeces or on the paper
- Anal itching (pruritus ani)
3
Q
What are the signs of anal of fissure upon physical examination?
A
- Tears in the squamous lining of the anus on examination
- Pain during DRE
4
Q
What investigations are used to identify anal fissures?
A
- Examine the anus
- Pain upon DRE
5
Q
How are anal fissures managed?
A
-Conservative
o High-fibre diet
o Softening the stools (laxatives)
o Good hydration
- Medical
o Lidocaine ointment (local anaesthetic)
o GTN ointment (relaxes the anal sphincter and promoted healing)
o Diltiazem (relaxes the anal sphincter and promotes healing)
o Botulinum toxin
injection - Surgical
o Lateral sphincterotomy
o This relaxes the anal sphincter and promotes healing but it has complications (e.g. anal incontinence) so it is reserved for patients who are intolerant or not responsive to non-surgical treatments
6
Q
What are the complications of Anal fissures?
Summarise the prognosis for patients with anal fissures
A
Complication: Chronic anal fissure
- In most people, the fissure will heal within a week or so
- Treatment revolves around easing pain by keeping the stools soft and relaxing the anal sphincter to promote healing
