Fissures-In-Ano Flashcards
1
Q
What is a fissure-in-ano
A
A painful tear in the squamous lining of the lower anal canal
2
Q
What are they most commonly due to
A
Hard faeces
3
Q
History
A
Painful passing of fresh blood
Pain begins with defecation and continues
Mucosal tag at external aspect (if chronic >6w)
4
Q
Common site and why
A
Posterior midline - this is where blood flow is lowest and skin is least supported
5
Q
Aims of treatment
A
to relax internal anal sphincter
6
Q
First line treatment
A
Correct constipation - increase fibre, fluids + stool softener
Avoid straining
Topical analgesics
7
Q
Second line treatment
A
Topical GTN
8
Q
Treatment when conservative measures fail
A
Surgery - internal anal sphincterotomy
