Haemorrhoids and Anal Fissures Flashcards
What are anal fissures?
Tears or ulcers in anal canal
Symptoms of anal fissures
Bleeding and persistent pain on defecation, linear split in the anal mucosa
Acute management if present for <6 weeks
Must ensure stools are soft and easily passed
Bulk-forming laxatives or osmotic laxatives
What is considered as acute anal fissures?
Present for <6 weeks
Treatment for for prolonged burning pain following defecation. When should it be avoided?
Short-term topical with local anaesthetic (lidocaine) or analgesic
Avoid in pregnant women
What is considered chronic anal fissures?
Present for 6 weeks +
Chronic management of anal fissures
GTN rectal ointment (high incidence of headache)
Topical/oral diltiazem or nifepidine (both unlicensed) (lower incidence of adverse effects, especially in topical)
Management of anal fissures when there is a failed response to drug treatment
Surgery
What are haemorrhoids?
Swelling of the vascular mucosal anal cushions around the anus (high risk during pregnancy)
Types of haemorrhoids and the symptoms associated
Internal = painless
External = itchy and painful
Non-drug treatment for haemorrhoids
Maintain easy stools to minimise straining: increase dietary fibre, fluid or bulk-forming laxative
Management of pain with haemorrhoids
Paracetamol
Which analgesics to avoid with haemorrhoids?
Opioids = constipation
NSAIDs = rectal bleeding
Treatment for haemorrhoids where there is pain/itching
Topical anaesthetics (lidocaine) = used for a few days
Topical corticosteroids = use no more than 7 days due to s/e
Treatment of haemorrhoids in pregnancy
Bulk-forming laxative
No topical haemorrhoidal preparations (only a simple soothing prep if needed)
