Anal fissures/haemorrhoids

Question 1

anal fissures - acute management

Answer 1

anal fissure - tear/ulcer in anal canal - bleeding and pain on defecation

acute:
ensure stool passes easily - bulk forming and osmotic laxative, short term topical local anesthetic lidocaine or analgesic

Question 2

anal fissures - chronic management

Answer 2

longer than 6 weeks - GTN rectal - high incidence of headache
topical/oral diltiazem, nifedipine
botulinum toxin type A - specialist

surgery effective when no drug response

Question 3

management of haemorrhoids

Answer 3

haemorrhoid - swelling of vascular mucosal cushions around anus - high risk during pregnancy

internal - no pain
external - pain/itchy

ensure stool passes easily - increase fibre/fluids , bulk laxative
pain - paracetamol, NSAID - rectal bleeding, opioid - constipation
topical local anaesthetic, corticosteroids, lubricant, antiseptics
- anaesthetics - short term few days
- corticosteroid - no longer than 7 days as S.Es

pregnancy - bulk laxative