Anal Fissure

Question 1

Define Anal Fissure:

Which direction do most anal fissures occur in?

Answer 1

A painful tear in the squamous lining of the lower anal canal

90% are posterior

Anterior tend to occur postpartum

Question 2

Summerise the epidemiology of Anal Fissures:

Answer 2

Affects 1/10

Both sexes equally

Most common at 10-30 yrs

Question 3

What are the possible causes of Anal Fissures:

Answer 3

Most caused by Hard Faeces

Others: Syphilis, Herpes, Trauma, Crohn’s, Anal cancer, Psoriasis

Question 4

How might Anal Fissures present?

Answer 4

Tearing pain on defecation

Small amount of blood in stools

Blood on Paper

Pruritus ani

Question 5

Generate a Conservative management plan for Anal Fissures:

Answer 5

High-fibre diet +/- laxatives

Good hydration

Oral Analgesia (+ topical anaesthetic)

Warm Baths

Question 6

What medical and surgical interventions may be required to manage Anal Fissures?

Answer 6

Medical:

• Lidocaine ointment
• GNT ointment (relaxes sphincter - promotes healing)
• Topical Diltiazem (vasodilation and muscle relaxation - promotes healing)
• Botox

Surgical

• Lateral sphincterotomy
  
  • Relaxes sphincter and promotes healing, but can cause incontinance

Question 7

What’s the prognosis for Anal Fissures?

(Include possible complications)

Answer 7

Heals within a week in most cases with conservative management

May lead to Chronic anal fissures w/extensive scarring, anal fistulas, anal stenosis