Anal fissures

Question 1

Define anal fissure:

Answer 1

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

Question 2

Summarise the epidemiology:

Answer 2

Affects 1 in 10 people

Affects both genders equally

In all ages but mainly younger people - 10-30 years

Question 3

Describe the aetiology/risk factors:

Answer 3

Hard stools - main cause

Anal sphincter spasm can constrict the internal rectal artery leading to ischaemia which impairs the healing process.

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

Question 4

what are the symptoms of anal fissures?

Answer 4

Tearing pain on defecation

There may be blood on the paper and in the faeces

Anal itching (pruritus ani)

Question 5

what are the signs of anal fissures?

Answer 5

Tear on physical examination

Question 6

what are investigations of anal fissures?

Answer 6

Examine the anus

Question 7

what is the management of anal fissures?

Answer 7

conservative - softening stools - laxatives, high fibre diet and good hydration.

Topical lidocane ointment
GTN ointment (relaxes anal sphincter and promotes healing)
Diltiazem (relaxes anal sphincter and promotes healing)
Botulism toxin

Surgical - lateral partial internal sphincterectomy (this is not usually done as there are lots of complications namely incontinence)

Question 8

what are the complications of anal fissures?

Answer 8

chronic anal fissures

Question 9

what is the prognosis of anal fissures?

Answer 9

usually heal within a week