Anal fissure

Question 1

what is an anal fissure?

Answer 1

Tear in the mucosal lining of the anal canal

Question 2

What causes anal fissures?

Answer 2

Trauma from defecation of a hard stool

Question 3

What is an acute vs chronic anal fissure?

Answer 3

acute is less than 6 weeks, chronic is more than 6 weeks

Question 4

What are the risks for anal fissures?

Answer 4

Constipation, dehydration, IBD and chronic diarrhoea as due to inflammation or trauma of the anal canal

Question 5

What are the clinical features of an anal tissue?

Answer 5

intense pain post defecation which may last several hours, bleeding, itching

Question 6

On examination how would an anal fissure present?

Answer 6

visible or palpable on DRE, most in the posterior midline, examination under anaesthetic is usually needed

Question 7

What are the differential diagnosis of a anal fissure?

Answer 7

Haemorrhoids, Crohns, UC, cancer

Question 8

What is the management of an anal fissure?

Answer 8

reduce risk factors and give analgesia, increase fibre and soften stool with laxatives, lidocaine (anaesthetic) GTN cream or Diltiazem as increase blood supply and relax internal anal sphincter, surgery, botox injections, lateral sphicterectomy but can cause incontinence