Anal Fissures Flashcards
Explain anal fissure
Tear in the mucosal lining of the anal canal
Causes
Defecation of hard stool usually
Classification
Acute - <6wks
Chronic >6wks
Primary (no underlying disease)
Secondary (usually IBD)
Risk factors
Inflammation or trauma to anal canal
Constipation
Dehydration
IBD
Chronic diarrhoea
Clinical features
Intense pain post-defecation that can last for several hours
Bleeding (bright red blood on wiping)
Itching
Examination findings
Fissures can be visible +/- palpable on DRE
Most fissures appear in the posterior midline
Anterior fissures are more likely to be found in females or in underlying disease.
Often patients will refuse a DRE.
What can be done instead?
Examination under anaesthesia (EUA) and can also be identified upon proctoscopy.
Dx
Haemorrhoids
Crohn’s
UC
Anal cancer
What does multiple fissures indicate?
Underyling cause
Medical management
Reducing risk factors
Adequate analgesia
Increase fibre and fluid intake
Stool softening laxatives like Movicol or Lactulose
Lidocaine and hotbaths can be tried as well.
If patients are still symptomatic GTN cream or diltiazem cream can be tried to increase blood supply and relax the internal anal sphincter.
Indications of surgery
Chronic fissures where medical management has failed
Surgical methods
Botox injections into internal anal sphincter to relax and promote healing
Lateral sphincterotomy with division of internal anal sphincter
Complications
Recurrence 1-5%
Faecal incontinence
