Anal Fissures And Haemorrhoids

Question 1

What is meant by anal fissures

Answer 1

Tear or ulcer in the anal canal causing bleeding and pain on defecation

Question 2

What is the acute management of Anal fissures

Answer 2

The aim is to ensure stools pass easily and help with pain
Bulk forming laxatives or osmotic laxatives
Short term topical with local anaesthetic (lidocaine) or analgesic- can use lidocaine or other analgesic in pregnant women

Question 3

What is the chronic management of anal fissures

Answer 3

6 weeks or longer: GNT rectal ( high incidence of headache)
Topical/ oral diltiazem or nifedipine (lower of adverse effects, especially in topical)
Specialist: botulinum toxin type A (Botox)

Surgery is effective when there is no drug response

Question 4

What is meant by haemorrhoids

Answer 4

Swelling if the vascular mucosal anal cushions around the anus ( high risk during pregnancy)

Internal = painless
External = itchy or painful

Question 5

How can you manage haemorrhoids

Answer 5

To maintain easy stools to minimise straining: increase fibre intake and fluid or bulking forming laxatives

Pain: paracetamol (opioids causes constipation so not advised and NSAIDs exacerbates rectal bleeding)

Pain/itching: topical preparations (anaesthetics, corticosteroids, lubricants, antiseptics)
- topical anaesthetic (lidocaine) - used for a few days
- topical corticosteroids - use no more than 7 days due to side effects

Pregnancy: bulk forming laxatives - no topical hemorrhoidal preparations (only a simple soothing prep if needed)