Anal Fissures And Haemorrhoids

Question 1

What are the aims of tx for anal fissure?

Answer 1

Relieve pain and promote healing.

Question 2

What is the length of time that defines acute anal fissure?

Answer 2

Less than 6 weeks

Question 3

What are the treatment options for acute anal fissure?

Answer 3

Bulk forming laxatives or osmotic laxative to ensure stools are soft and easily passed. Short term local anaesthetic and simple analgesics. If measures are inadequate, patient should be referred.

Question 4

What is the treatment options for chronic anal fissure?

Answer 4

Gtn rectal ointment (high strength not necessarily the best, increase risk of se-headaches) topical dilitazem or nifedipine (both unlicensed) can be used but at higher risk of adr.

Question 5

What are the aims of tx for piles?

Answer 5

Reduce symptoms, promote healing and prevent recurrence.

Question 6

What non drug tx can you give to a piles pt?

Answer 6

Increase fibre and fluid intake to reduce constipation and improve stool texture and consistency, perianal hygiene ,dab not wipe.

Question 7

Drug tx for piles?

Answer 7

Bulk dormers for constipation, simple analgesics (avoid opioids as can cause constipation and nsaid as can make rectal bleeding worse) topical preparations (anusol) no evidence to suggest one preparations is better than the other.

Question 8

How long should topical corticosteroids be used for?

Answer 8

Occasional short term use, no more than 7 days as can cause ulceration and permanent damaged due to thinning if skin. Recurrent symptoms re

Question 9

What drug options care recommended in pregnancy?

Answer 9

Bulk formers, topical preparations only containing soothing products, no steroids or or anaesthetic. No topical preparations are licensed in pregnancy.

Question 10

What s/e can be expected with topical preparations of corticosteroids?

Answer 10

Can be absorbed through rectal mucosa, therefore systemic s/e, sensitisation, s