Fissure in Ano

Question 1

What is fissure in ano?

Answer 1

A tear in the sensitive anal canal, distal to the dentate line, producing pain on defecation

Question 2

What are the symptoms of fissure in ano?

Answer 2

Pain on defecation (lasting for hours after)
Constipation
Pruritis ani
Bleeding on defecation-bright red

Question 3

What are the signs of fissure in ano?

Answer 3

Midline longitudinal tear in rectal mucosa-often posterior midline
-if anywhere else consider alternate cause e.g. Crohns
Sentinal pile/mucosal tag at external aspect

Question 4

What investigations are appropriate in suspected fissure in ano?

Answer 4

Proctoscopy/sigmoidoscopy (exclude other anorectal disease)
-enlarged nodes in groin suggest complicating factor

DRE often cannot be completed due to immense pain

Question 5

What are the causes of fissure in ano?

Answer 5

Constipation
IBD
STI

Question 6

Why do fissures in ano occur more commonly at the midline?

Answer 6

Blood supply worse, healing more difficult

Question 7

What are the management options for acute fissures?

Answer 7

Stool softeners

• increase fibre and fluid intake
• bulk forming laxatives- if unable to take then consider lactulose

Topical anaesthesia
Petroleum jelly before defecation
Analgesia

Question 8

What are the management options for chronic fissures in ano?

Answer 8

> 6 WEEKS

• 0.4% GTN cream
• botox injections (last 8wks, incontinence after) or sphincterotomy (referral to surgery) under GA