Anal fissures and haemorrhoids

Question 1

what are anal fissures?

Answer 1

they are a tear or ulcer in the anal canal causing bleeding and pain on defecation

Question 2

what is the management for anal fissures?

Answer 2

acute management: ensure stools passes easily
-bulk-forming laxatives or osmotic laxatives
-short term topical with local anaesthetic (lidocaine) or analgesic (not ion pregnant women)

chronic
-6 weeks or longer: GTN rectal (high incidence of headache)
-topical/oral diltiazem or nifedipine (lower of adverse effects, especially in topical)
-specialist: botulinum toxin type A

-surgery if no response to drugs

Question 3

what are haemorrhoids?

Answer 3

-swelling of the vascular mucosal anal cushions around the anus (high risk during pregnancy)
-internal (painless) or external (itchy or painful)

Question 4

how do you manage haemorrhoids?

Answer 4

maintain easy stools to minis straining. increase dietary fibre + fluid or bulk-forming laxatives
-pain: paracetamol only (opines cause contraption and NSAIDS exacerbate rectal bleeding)
-pain/itching: topical preparations (anaesthetics, corticosteroids, lubricant, antiseptics) e.g. TOPICAL anaesthetics like lidocaine only for a few days or topical corticosteroid use no more than 7 days due to SE
-pregnancy: bulk forming laxatives- no topical preparations (only soothing simple prep if needed but no medication)