anal fissure

Question 1

What is an anal fissure?

Answer 1

a longitudanal tear in the mucosa and skin of anal canal

Question 2

What is anal fissure caused by?

Answer 2

1. large constipated stool

Question 3

Where are anal fissures found?

Answer 3

1. posterior midline of anal margin
2. distal to dental line
3. 6 o clock

Question 4

What are the clinical features of anal fissure?

Answer 4

1. sharp pain during defecation
2. bright red rectal bleeding
3. perianal pruritus
4. chronic constipation

Question 5

What is seen on clincal examination?

Answer 5

1. laceration
2. skin tags - senile piles
3. avoid DRE as v painful

Question 6

Conservation mx

Answer 6

1. improve diet/fibre/water

2. topical gtn ointment to relax sphincter

Question 7

Surgical mx

Answer 7

• last line of mx due to high risk of fecal incontinence *

1. GS - sphincterectomy of internal sphincter - preserving external sphincter crucial to maintain fecal continence