Anal Fissure Flashcards
What is a anal fissure
tear in the mucosal lining of the anal canal
What is the most common cause of anal fissures
due to trauma from defecation of hard stool
How can anal fissures be classified
Into acute and chronic
Acute: present for less than 6 weeks
Chronic: present for more than 6 weeks
Other than acute and chronic, how else can anal fissures be categorised
Primary - no underlying disease
Secondary - secondary to underlying disease eg IBD
What are the risk factors of anal fissures
Constipation
Dehydration
Inflammatory bowel disease
Chronic diarrhoea
What are the clinical features of anal fissures
Intense pain post defecation which can last for hours sometimes.
Bleeding
Itching
Where are most anal fissures present
Posterior midline
Anterior fissures are more common in females/ if there is a underlying cause
What are the differential diagnosis of anal fissures
Haemorrhoids
UC
Crohns
Anal cancer
What is the fist line medical management of anal fissures
Analgesia - avoid opioids as can make things worse
Increase fibre and fluid intake
Stool softening laxatives ( movicol/lactulose)
Hot baths
What is the second line medical management of anal fissures
GTN cream
Diltiazem cream
The above increases blood flow to the area promoting growth and healing
When is surgical management for anal fissures Indicated
chronic fissures where medical management has failed to resolve the symptoms
what surgical management options are available
Botox injections to relax the internal anal sphincter and aid healing process.
Lateral sphincterotomy
What is the recurrence rate of anal fissures post surgery
1-5% but mostly those pts have a underlying cause
What is the main complication of surgery
Faecal incontinence
