GI: Anal fissure

Question 1

What is an anal fissure?

Answer 1

An anal fissure is a tear or ulcer in the lining of the anal canal, immediately within the anal margin.

Question 2

What should initial management of acute anal fissures (present for less than 6 weeks) focus on?

Answer 2

Ensuring that stools are soft and easily passed.

Question 3

Bulk-forming laxatives (such as ______ ______) are recommended as initial management of acute anal fissures (present for less than 6 weeks).

Answer 3

Isaghula husk is a bulk-forming laxative.

Question 4

An osmotic laxative (such as ________) can be considered as an alternative to bulk-forming laxatives in the intitial management of anal fissure.

Answer 4

Lactulose is an osmotic laxative.

Question 5

Short-term use of a topical preparation containing a local anaesthetic (such as _________) or a simple anaglesic may be offered for prolonged burning pain following defecation in acute anal fissure.

Answer 5

Lidocaine hydrochloride.

Question 6

Chronic anal fissures (present for 6 weeks or longer) may be treated with what? (4)

Answer 6

1. Glyceryl trinitrate rectal ointment (the higher strength may cause increased side effects with no additional benefit).
2. Diltiazem hydrochloride 2%
3. Nifedipine 0.2-0.5%
4. Local injection of botulinum toxin type A.