Anal fissure

Question 1

Define anal fissures

Answer 1

Small tear/ulcer in squamous lining of anal canal

Question 2

What is the aetiology of anal fissures?

Answer 2

Trauma from passing a hard stool tears perianal skin distal to the dentate line

Chronic spasm (constrict inf rectal a. = ischaemia)
Increased tone of internal anal sphincter
Lack of NOS
Chronic constipation
anal

Question 3

What is the epidemiology of anal fissures?

Answer 3

90% of fissures are posterior. Anterior ones are parturition-caused
Male=female
15-40y
1 in 350

Question 4

What are the symptoms of anal fissures?

Answer 4

Pain when passing stools
PR bleeding
Perianal pruritis
Tearing sensation (ouch)
Fresh blood on paper
Anal spasm

Question 5

Name RFs for anal fissures

Answer 5

Pregnancy
Hard stools
Opiate analgesia

Question 6

What is the treatment for anal fissures?

Answer 6

ACUTE - conservative tx, increase fibre, fluids. Provide topical analgesia, sitz bath, stool softener. Topical GTN (to vasodilate - causes headaches)/diltiazem

RESISTANT - Botox injection to relax sphincter, lateral internal sphincterotomy decreasing spasm and increasing bloodflow (division of sphincter, can weaken = incontenance)

Question 7

What is the prognosis of anal fissures?

Answer 7

60% heal btwn 6-8 wks
20% heal after topical diltiazem
30% relapse - needs surgery

Question 8

Name some complications associated with anal fissures

Answer 8

Chronic fissure
Incontinence
Recurrence

Question 9

Name the investigations carried out for anal fissures

Answer 9

NOT DRE
anal manometry (low resting pressure)
anal US (sphincter defects)