Surgery

Question 1

Anal fissure

Answer 1

Risk factors: constipation, STI, IBD

Sx: bright red rectal bleeding (majority in the posterior midline)

Mx:
Acute (<1 week)
- soften stool: dietary advise, bulk forming laxatives
- lubricants before defecation
- topical anaesthetics
- analgesia

Chronic
- first line: GTN
- if it doesn’t work after 8 weeks referral should be considered for surgery (sphincterotomy) or botulinum toxin