Anal fissure Flashcards
What is an anal fissure
split in skin of distal anal canal
second most common GI complication of pregnancy after hemorrhoids
What differentiates acute vs chronic anal fissure
acute <6 weeks
chronic >6 weeks
What are some risk factors
constipation
IBD
STIs
Pregnancy
opiates
What may someone with an anal fissure present with
painful, bright red, rectal bleeding
tearing sensation when passing stool
fresh blood on stool OR paper
anal spasm
How is anal fissure investigated
Based on clinical diagnosis
What investigations should be considered for someone with an anal fissure
Anal manometry - in patient with resistant fissures
Anal US- in patients with suspected anal sphincter deficits
How do you manage acute anal fissures
- SOFTEN STOOL
high fibre diet with high fluid intake
BULK-FORMING LAXATIVE
petroleum jelly lubricant before defecation
topical anaesthetics
analgesia
What are examples of some bulk forming laxatives
ISPAGHULA HUSK
METHYLCELLULOSE
How do you manage chronic anal fissures
Continue all the acute management
Topical GTN
if not effective refer for sphincterotomy or botulinum toxin
