Anal fissure

Question 1

anal fissure

Answer 1

Tear in the mucosa of the anal canal, just inside the anal margin, occurs below the dentate line so is somatic sensory

Question 2

aetiology of anal fissure

Answer 2

• 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

Question 3

symptoms of anal fissure

Answer 3

• 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

Question 4

signs of anal fissure

Answer 4

The fissure can be seen on external examination of the anus - usually in the midline posteriorly but may occasionally be anterior

Question 5

investigations of anal fissure

Answer 5

Diagnosis is clinical and further investigation is only required if there are features of underlying pathology

Question 6

management of anal fissure

Answer 6

• 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