Anal Fissure Flashcards
what is anal fissure
tearing in the squamous lining of the distal anal canal
how may a patient describe the pain with an anal fissure
feels as though they are passing broken glass
aetiology (causes) of anal fissure
hard faeces, damaged anal canal, anal sphincter spasm can constrict the inferior rectal artery leading to ischaemia and impairs the healing process
rare causes of anal fissure
syphilis, herpes, trauma, crohns, anal cancer and psoriasis
epidemiology of anal fissures
1/10 people get it in a lifetime, females = males, most common in young and middle aged adults (10-30 years)
risk factors
pregnancy, hard faeces and opiate analgesia
diagnostic factors
pain and tearing sensation when passing stool, fresh blood on stool/ paper, anal spasm and anal itching
why aren’t any investigations needed to confirm an anal fissure
on anal examination, a fissure can be seen; tears in the anal squamous lining
3 categories of management of an anal fissure
conservative, medical and surgical
conservative management
high fibre diet, good hydration and softening the stool (laxatives)
medical management
Lidocaine ointment (local anaesthetic)
GTN ointment (relaxes the anal sphincter and promoted healing)
Diltiazem (relaxes the anal sphincter and promotes healing)
Botulinum toxin injection
surgical management
Lateral sphincterotomy
This relaxes the anal sphincter and promotes healing but it has complications (e.g. anal incontinence) so it is reserved for patients who are intolerant or not responsive to non-surgical treatments
complications of anal fissures
chronic anal fissure
prognosis
In most people, the fissure will heal within a week or so
Treatment revolves around easing pain by keeping the stools soft and relaxing the anal sphincter to promote healing
