Anal fissure

Question 1

What is it?

Answer 1

Tearing in anal canal
Most occur in posterior midline
Often secondary to constipation and hard stools
Acute <6 weeks
Chronic ?6 weeks

Question 2

What are clinical features?

Answer 2

Severe, sharp anal pain during or after defecation
Fresh PR bleeding
Can normally visualise a small wound

Question 3

What is the management?

Answer 3

1) Treat underlying constipation e.g. laxatives and fibre intake
2) Analgesia e.g. topical anaesthetic to apply before defecation
3) If symptoms persist >1 weeks then
- topical GTN ointment BD for 6-8 weeks (can cause headache)

4) if fissure persists
- If imrpoves with GTN then second course
- no improvement then try topical diltiazem or refer to surgery

Secondary care options
- botox
- lateral internal sphincterotomy