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

Question 3

What are the signs of fissure in ano?

Answer 3

Midline longitudinal tear in rectal mucosa

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

Question 5

What are the causes of fissure in ano?

Answer 5

Hard faeces (most common)
Parturition (10% ant)
Infections (syphilis/herpes)
Trauma
Chron's
Anal cancer
Psoriasis

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 early, small fissures in ano?

Answer 7

May heal spontaneously
Local anaesthetic/lubricant laxative (symptomatic)
High fibre diet
Fluids
Bulk-forming laxative

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)

Question 9

What are the management options for intractable/recurrent fissures in ano?

Answer 9

Sphincterotomy

-submucosal division of external sphincter under GA