Anal Fissure Flashcards
Define Anal Fissure?
A painful tear in the squamous lining of the lower anal canal
What are most anal fissures?
90% of anal fissures are posterior (anterior anal fissures tend to occur after childbirth)
What is the epidemiology of Anal Fissures?
Affects 1/10 people during their life time
Both sexes are affected equally
Can occur at any age
Most cases occur in children and young adults: 10-30 years
What is the aetiology of Anal Fissures?
Most are caused by hard faeces
Anal sphincter spasm can constrict the inferior rectal artery, causing ischaemia and impairing the healing process
What are the rarer causes of Anal Fissures?
Syphilis Herpes Trauma Crohn's Anal Cancer Psoriasis
What are the presenting symptoms of Anal Fissures?
Tearing pain when passing stools There may be a little bit of blood in the faeces or on the paper Anal itching (pruritus ani)
What are the signs of Anal Fissures on physical examination?
Tears in the squamous lining of the anus on examination
What investigations would you do for Anal Fissures?
Examine the anus
What is the conservative management plan for Anal Fissures?
High-fibre diet
Softening the stools (laxatives)
Good hydration
What is the medical management plan for Anal Fissures?
Lidocaine ointment (local anaesthetic)
GTN ointment (relaxes the anal sphincter and promoted healing)
Diltiazem (relaxes the anal sphincter and promotes healing)
Botulinum toxin injection
What is the surgical management plan for Anal Fissures?
Lateral sphincterotomy
This relaxes the anal sphincter and promotes healing but it has complications (e.g. anal incontinence) so it is reserved for patients who are intolerant or not responsive to non-surgical treatments
What are the possible complications of Anal Fissures?
Chronic anal fissure
What is the prognosis for patients with Anal Fissures?
In most people, the fissure will heal within a week or so
Treatment revolves around easing pain by keeping the stools soft and relaxing the anal sphincter to promote healing
