Anal Fissures Flashcards
What are anal fissures?
They are defined as longitudinal tears of the lining in the distal anal canal
What cells line the distal anal canal?
Non-keratinised stratified squamous epithelium
Where do anal fissures most commonly occur?
Posterior midline
What is indicated when anal fissures are located in an alternative location to the posterior midline?
Inflammatory bowel disease
What are the two classifications of anal fissures?
Acute Anal Fissures
Chronic Anal Fissures
What are acute anal fissures?
They are defined as those which are present for a period of less than six weeks
What are chronic anal fissures?
They are defined as those which are present for a period greater than six weeks
What are the six risk factors of anal fissures?
Constipation
Persistent Diarrhoea
Inflammatory Bowel Disease
Anal Cancer
Sexually Transmitted Infections
Childbirth
Which three sexually transmitted infections are associated with anal fissures?
HIV
Syphillis
Herpes
What are the four clinical features assoicated with anal fissures?
Bright Red Rectal Bleeding
Defecation Pain
Burning Anal Pain > Defecation
Anal Tear
How are anal fissures diagnosed?
Clinically
In most cases, investigations aren’t required
What are the three conservative management options of anal fissures?
High-Fibre Diet
High Fluid Intake
Regular Exercise
What are the two pharmacological managements of acute anal fissures?
Bulk-Forming Laxatives
Osmotic Laxatives
When are bulk-forming laxatives used to manage acute anal fissures?
They are the first line pharmacological management option
Name two bulk-forming laxatives used to manage acute anal fissures
Ispaghula husk
Methylcellulose
When are osmotic laxatives used to manage acute anal fissures?
They are the second line pharmacological management option
Name an osmotic laxative used to manage acute anal fissures
Lactulose
What is the pharmacological management option of chronic anal fissures?
Topical Glyceryl Trinitrate (GTN)
When is topical GTN used to manage chronic anal fissures?
It is the first line management option of chronic anal fissures
How long should topical GTN be trialled for? What is the next appropriate management step in cases where clinical features persist?
8 weeks
Secondary care referral
What is the surgical management option of chronic anal fissures?
Sphincterotomy
When is sphincterotomy used to manage chronic anal fissures?
It is the second line management option of chronic anal fissures when conservative management is deemed unsuccessful
What is sphincterotomy?
It involves incision of the lateral internal anal sphincter
