Mangement of Anal Fissure

Question 1

Where are anal fissures located?

Answer 1

Usually 6’o clock position

Question 2

What is the pertinent physiology of fissures?

Answer 2

Linear or rocket shaped ulcers usually less than 5 mm in length
occur about ten percent anteriorly
if occurring off midline investigate more seroous diseases or investigate sexual assault

Question 3

What is the pertinent pathophysiology of anal fissures/.

Answer 3

mostly believed to arise from trauma to the anal canal during defecation due to straining, constipation, or high internal sphincter blood may be seen on stool or toilet paper

Question 4

What are the symptoms?

Answer 4

Patients will complain of severe, tearing pain during defecation followed by throbbingg discomfort that may lead to constipation due to fear of recurrent.
confirmed by visual inspeciton fo the anal verge while gently separating the buttocks

Question 5

What are the physical findings of anal fissures?

Answer 5

Acute fissures look like cracks in the epithelium
chronic fissures result in fibrosis and the development of a skin tag at the outermost edge
digital and anoscopic exams may cause sever pain and may not be possible

Question 6

What are the differential diagnosis of anal fissures?

Answer 6

perianal abcess
condyloma acuminata
skin tag
crohn’s disease

Question 7

How should you treat anal fissures?

Answer 7

Managemend directed at promoting effotless, painless bowel movements
daily fiber supplements and sitz baths
topical anesthetics before BMs

Question 8

What pain meds can you give for anal fissures?

Answer 8

Analgesics or NSAIDS. Oral.

Question 9

How fast do anal fissures normally heal?

Answer 9

Within 2 months in up to 45% of patients with conservative management
Chronic fissures should be referred and may be treated with topical nitro or diltiazem or with an injection of botulinum toxin withink the internal anal sphincter