Anal fissure

Question 1

what is it?

Answer 1

Definition: a painful tear in the squamous lining of the lower anal canal

NOTE: 90% of anal fissures are Posterior (anterior anal fissures tend to occur after childbirth)

acute fissure; had for up to 6weeks

Question 2

management of acute fissure?

Answer 2

Conservative:
1. Softening the stools - Bulk-forming laxatives (such as ispaghula husk) 1st line
Good hydration
High-fibre diet

Medical
2. Lidocaine hydrochloride (local anaesthetic)
Or paracetamol PO

Question 3

mx of chronic fissure - (persisting or more than 6 wks)?

Answer 3

Medical:
1st - GTN rectal ointment 0.4% (relaxes the anal sphincter and promoted healing)
2nd - Diltiazem (relaxes the anal sphincter and promotes healing)
4th - Botulinum toxin injection

Surgical - if dont respond to all lines of drugs
Lateral sphincterotomy
This relaxes the anal sphincter and promotes healing but it has complications (e.g. anal incontinence) so it is reserved for patients who are intolerant or not responsive to non-surgical treatments