(!) Anal fissure

Question 1

Define Anal fissure

Answer 1

Split in the skin in distal anal canal-and usually go away with time (1-2 weeks-but quite a few don’t)
quite common cause of poop pain and rectal bleeding

AFFECTS QOL A lot

Question 2

Aetiology and risk factors of Anal fissure

Answer 2

Hard stool bolus can precipitate a tissue (constipation)
can also happen with loose stools-no obvious cause
classically-hard stool tear the anal skin-but might be an ischemic ulcer
affects QOL a lot

Risk factors-
hard stools
constipation
use of opiates (analgesia or not)
Pregnancy

Question 3

Epidiemology of Anal fissure

Answer 3

1 in 350 -common
often both sex between 15-40
can be in children w/ bad toileting
2nd commonest complication after pregnancy

Question 4

Signs and Sx of Anal fissure

Answer 4

Most common:
SHARP Pain on defecation, tearing sensation as poo
Anal spasm
Bright blood in poo/paper

DRE-sentinel piles (little growth out anus)
Can see fissure
Spasm as approach finger

Question 5

Investigations of Anal fissure

Answer 5

Clinical + DRE

no lab tests

Question 6

Management of Anal fissure

Answer 6

Conservative treatment-better diet (no hard stools) + topical analgesia + stool softeners

can use topical Glyceryl trinitrate (GTN)-Sx relief
Topical Dilitazem (like GTN but no headache side effect)

persistant tissue-
Botox injection
Surgical repair

Question 7

Complications of Anal fissure

Answer 7

Chronic anal fissure commonly develop-QOL down

Surgery can lead to temporary incontinence

Reccurence is low, as long as treatment in completed

Question 8

Prognosis of Anal fissure

Answer 8

60% will heal within 6-8 weeks
20% extra after topical dilitazem

30% need surgery