Anal Fissures

Question 1

What are anal fissures?

Answer 1

Liner or rocket shaped ulcers usually <5cm in length

Question 2

Where do anal fissures most commonly occur?

Answer 2

Posterior midline, 10% occur anteriorly

Question 3

Fissure off midline should raise suspicion for?

Answer 3

Serious disease or sexual assault

Question 4

What are the common causes of anal fissures?

Answer 4

Trauma during defecation, straining, constipation or high sphincter tone

Question 5

If a patient complains of severe tearing, pain during defecation followed by throbbing discomfort, what condition might they have?

Answer 5

Anal fissures

Question 6

How are anal fissures confirmed?

Answer 6

Visual inspection by separating them butt cheeks

Question 7

What do acute fissures look like?

Answer 7

Cracks in the epithelium

Question 8

What do chronic fissures result in?

Answer 8

Fibrosis and development of skin tags at the outermost edge

Question 9

Management of anal fissures is directed at promoting what?

Answer 9

Effortless, painless, bowel movements

Question 10

What are conservative treatments for anal fissures?

Answer 10

Fiber supplements, sitz baths

Question 11

How long does anal fissure healing occur with conservative management?

Answer 11

Within 2 months in up to 45% of patients

Question 12

Chronic fissures may be treated with?

Answer 12

Topical nitroglycerin, diltiazem or with botulinum toxin into the internal anal sphincter