Anal Fissure

Question 1

Define anal fissue.

Answer 1

An anal fissure is a tear or open sore (ulcer) that develops in the lining of the anal canal.

Question 2

Explain the aetiology/risk factors for anal fissue.

Answer 2

Constipation: Straining and passing hard stool tears the posterior anal lining.

• Opiates can precipitate constipation.
• Inflammatory bowel disease
• Infection
• Traumatic injury

Question 3

Summarise the epidemiology of anal fissures.

Answer 3

Most fissures occur between 6-24 months of age.

Question 4

What are symptoms of anal fissure?

Answer 4

• Pain/crying with bowel movements.
• Streaks of bright red blood on the stool or nappy.
• Fever, rashes, weight loss, diarrhea (overflow?).

Question 5

What are the signs of anal fissure?

Answer 5

• Minor laceration usually in the midline.
• Small, external skin tag.
• Palpable masses (stool) in the abdomen.
• Skin changes
• Systemic signs.

Question 6

What are appropriate examinations for an anal fissure in a child?

Answer 6

A clinical diagnosis but can exclude other pathology.

Viral serology, TB, stool cultures, biopsy for IBD.

Conduct an AXR to assess extent of fecal impaction.

Note: It may not be possible to do a digital rectal examination as the pain may be prohibitive.

Question 7

What is the management for anal fissure?

Answer 7

Conservative: Change diet and drink more fluids to soften stools. Can try sitz baths.

Medical: Topical GTN or diltiazem. Also prescribe stool softeners (polythene glycol or lactulose). Botox can be considered.

Surgery: Open lateral internal sphincterotomy.

Question 8

What are possible complications for anal fissure in a child?

Answer 8

Chronic fissures and chronic pain.

GTN can cause headaches and diarrhoea.

Question 9

What is the prognosis for anal fissure in a child?

Answer 9

Most infants will have full recovery.

Chronic fissures are more likely in inflammatory bowel diseases.