Anal Fissures

Question 1

What is it?

Question 2

Whp can get anal fissures?

Answer 2

More commonly very old or young

• Traumatic= passing large/hard stools, straining, chronic diarrhoea, anal intercourse, childbirth
• Non-traumatic= IBD, anal cancers, HIV, TB, Syphilis

Question 3

Symptoms?

Answer 3

Pain during/after bowel movements

• Bright red blood on paper post wipe
• Visible crack on skin or small lump/tag

Question 4

Investigations?

Answer 4

• Good history
• Direct exam ]
• History lasting longer than 8 weeks = chronic

Scoping= More concerning signs ***

Question 5

Management of acute?

Answer 5

Topical nitroglycerin
Topical anaesthetic (lidocaine)
Botox injection

Question 6

Surgical treatment?

Answer 6

Lateral internal sphincterotomy

-Small incision is made to sphincter muscles NOT CUTTING OUT fissure