Anal Fissures

Question 1

Define anal fissures

Answer 1

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

Question 2

Summarise the epidemiology of anal fissures

Answer 2

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 yrs

Question 3

What causes anal fissures?

Answer 3

Most are caused by hard faeces

Anal sphincter spasm can constrict the inferior rectal artery, causing ischaemia and impairing the healing process

Rare causes: syphilis, herpes, trauma, Crohn’s, anal cancer, psoriasis

Question 4

What are the presenting symptoms of anal fissures?

Answer 4

Tearing pain when passing stools 
There may be a little bit of blood in the faeces or on the paper 
Anal itching (pruritus ani)

Question 5

What will you find with anal fissures on PE?

Answer 5

Tears in the squamous lining of the anus on examination

Question 6

What is conservative management for anal fissures?

Answer 6

High-fibre diet
Softening the stools (laxatives)
Good hydration

Question 7

What is the medical management for anal fissures?

Answer 7

o Lidocaine ointment (local anaesthetic)

o GTN ointment (relaxes the anal sphincter and promoted healing)

o Diltiazem (relaxes the anal sphincter and promotes healing)

o Botulinum toxin injection

Question 8

What is the surgical management for anal fissures?

Answer 8

Lateral partial internal sphincterotomy

oThis relaxes the anal sphincter and promotes healing but it has complications (e.g. anal incontinence)

reserved for patients who are intolerant or not responsive to non-surgical treatments

Question 9

What is the prognosis for an anal fissure?

Answer 9

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