Anal fissure Flashcards
1
Q
anal fissure
A
Tear in the mucosa of the anal canal, just inside the anal margin, occurs below the dentate line so is somatic sensory
2
Q
aetiology of anal fissure
A
- Usually due to passage of a constipated stool
- Multiple fissures may be due to Crohn’s disease
- If older patient presents with their first episode of anal fissure, consider anal cancer as a posibility
3
Q
symptoms of anal fissure
A
- Acute onset of severe anal pain usually following an episode of constipation
- Patients often say they feel like theyre shitting glass
- Pain lasts for up to 30 mins after defecation
- Bright red rectal bleeding
4
Q
signs of anal fissure
A
The fissure can be seen on external examination of the anus - usually in the midline posteriorly but may occasionally be anterior
5
Q
investigations of anal fissure
A
Diagnosis is clinical and further investigation is only required if there are features of underlying pathology
6
Q
management of anal fissure
A
- They normally heal on their own given the right conditions
- Treatment usually involves dietary advice, an anaesthetic cream and a stool softener
- Pharmacological sphincterotomy (GTN, diltiazem) may be used
- Chronic – lateral sphincterotomy, Botox injection