Anal fissures

Question 1

What is an anal fissure?

Answer 1

Tear or ulcer in the lining of anal canal.

Question 2

Symptoms - anal fissure

Answer 2

Bleeding (bright red blood)
Sharp, persistent pain on defecation.
Linear spilt in anal mucosa

Question 3

Acute anal fissures (<6 weeks)

Answer 3

Ensure stools are soft/easy to pass
- Bulk forming laxative OR osmotic

Pain relief
- Simple analgesia
- Warm bath

Prolonged burning pain following defecation
- Topical anaesthetic e.g. lidocaine 5% (1-2 mL PRN)

Question 4

Chronic anal fissures (> 6 weeks)

Answer 4

• GTN 0.4% ointment to aid healing.
• BD for 6-8 weeks
• Headache is a common side effect
• Alternatives = oral/topical diltiazem, nifedipine

Question 5

Haemarrhoids

Answer 5

Swelling of anal mucosal cushion contianing enlarged blood vessels.
Inside or outside anus

Question 6

Haemorrhoids - symptoms

Answer 6

Pain after defecation
Bleeding after defecation
Swelling/lumps
Itchy, sore skin around anus

Question 7

Haemorrhoids - risk factors

Answer 7

Pregnancy
Constipation

Question 8

Haemorrhoids - lifestyle advice

Answer 8

Increase fibre + fluid intake
Perianal hygiene

Question 9

Management (Haemarrhoids)

Answer 9

Ensure stools are soft and easy to pass
- Bulk forming or osmotic laxative

Pain relief
- AVOID opioids and NSAIDs in rectal bleeding

Question 10

Haemorrhoids - topical preparations

Answer 10

Local pain
- Preparations with local anaesthetics (lidocaine, cinchocaine, pramocaine)
- Max few days use

Local perianal inflammation
- Preparations with corticosteroids (hydrocortisone, prednisolone, fluocortolone)
- Max 7 days use