Anal fissure

Question 1

What is an anal fissure?

Answer 1

Anal fissure is a split in the skin of the distal anal canal characterised by pain on defecation and rectal bleeding.

Question 2

What are the risk factors of an anal fissure?

Answer 2

Hard stool
Pregnancy
Opiate analgesia

Question 3

What is the epidemiology of anal fissures?

Answer 3

Incidence is 1 in 350
Equally common in men and women
15-40 yrs

Question 4

What are the signs and symptoms of anal fissures?

Answer 4

Pain on defaecation
Tearing sensation when passing stool
Fresh blood on stool or paper
Anal spasm
Intermittency
Sentinel pule
Visible fissure

Question 5

What are the appropriate investigations for anal fissures?

Answer 5

Clinical diagnosis
Anal manometry
Anal US

Question 6

What results may you expect with anal fissures?

Answer 6

Clinical history
Low resting pressure via manometry
US- defects in internal or external anal sphincter

Question 7

What is the management plan for anal fissures?

Answer 7

> Conservative treatment (high fibre diet, fluids, topical analgesia and stool softeners)
Topical GTN
Topical Diltiazem
Botulinum toxin, surgical sphincterotomy, anal advancement flap

Question 8

What are the complications of anal fissures?

Answer 8

Chronic anal fissure
Incontinence (post surgery)
Recurrence

Question 9

What is the prognosis of patients with anal fissures?

Answer 9

Approximately 60% of patients will achieve healing of their fissure at 6 to 8 weeks.

A further 20% will heal after a course of topical diltiazem.

Some of these patients may subsequently relapse; around 30% will require a surgical option.