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Anal Fissure
- Pathophysiology
- Usually follows trauma or Diarrheal illness
- Chronic increase in resting anal pressure
- Increased anodermal blood flow causes fissures
- Epidemiology
- Affects young and middle-aged adults
- Men and women are equally affected
- Symptoms
- Onset after forced hard Bowel Movement
- Bright red rectal bleeding
- Pain during Bowel Movement
- Cut with sharp glass sensation
- Pain persists for an hour after stooling
- Signs
- See Anorectal Exam
- Avoid Anoscopy if possible
- Painful and usually not needed
- Use Local Anesthesia if performed
- Crack or crevice in anoderm at anal verge
- Usually in canal midline (anterior or posterior)
- Lateral suggests other diagnosis (see below)
- Best seen with lateral traction on opposite buttock
- Sentinel pile (distal Skin Tag)
- Tag-like swelling of fissure end
- Results from infection and edema
- Differential Diagnosis
- See Anorectal Pain
- Conditions resulting in lateral anal fissure
- Inflammatory Bowel Disease (e.g. Crohn's Disease)
- HIV Infection
- Tuberculosis
- Syphilis
- Leukemia
- Anorectal cancer
- Management
- Early Management
- Bulk Dietary Fiber
- Increase fluid intake
- Sitz baths
- Topical Hydrocortisone (e.g. Proctofoam HC)
- Xylocaine 5%
- Glyceryl trinitrate ointment 0.2% bid for 6 weeks
- Reduces maximal anal resting pressure
- Study of 80 patients over 8 weeks
- Fissures healed in 68% using glyceryl ointment
- Adverse effects: Headache
- Only 8% healed with standard delivery
- Lund (1997) Lancet :
- Late Management (>3 months)
- Difficult to treat if persistent beyond 3 months
- Topical Nifedipine 0.3% and Lidocaine 1.5% ointment
- Apply twice daily for 6 weeks
- Resulted in 94.5% rate of healing
- Perrotti (2002) Dis Colon Rectum 45:1468
- Invasive procedures
- Surgery: Lateral sphincterotomy (preferred)
- Botulin toxin injection
- Unclear long term efficacy
- Adverse effects
- Short term fecal Incontinence in 5-7%
- Long term flatus Incontinence is uncommon
- References
- Early Management
- References
Anal Fissure (C0016167) | |
|---|---|
| Definition (MSH) | A painful linear ulcer at the margin of the anus. It appears as a crack or slit in the mucous membrane of the anus and is very painful and difficult to heal. (Dorland, 27th ed & Stedman, 25th ed) |
| Concepts | Acquired Abnormality (T020) , Disease or Syndrome (T047) |
| ICD9 | 565.0, 569.43 |
| MSH | D005401 |
| English | Anal Fissure, Anal Ulcer, Anal ulcer unspecified, ANAL ULCERATION, Anal Ulcers, Fissure in Ano, Fissure-in-ano, Nontraumatic tear of anus, Solitary anal ulcer, Solitary ulcer of anus, Ulcer of anus |
| French | Fissure anale |
| Italian | Ragade anale |
| Spanish | desgarramiento atraumatico del ano, fisura anal, fisura en el ano, ulcera anal, ulcera anal no especificada, ulcera anal solitaria, ulcera del ano, ulcera solitaria del ano |
| Parent Concepts | Anorectal disorder (C0687707), Anal fissure and fistula NOS (C0156175), Anus Diseases (C0003462), Anal Fissure (C0016167), Ulceration of colon (C0267491), Ambiguous concept (C1274012), Duplicate concept (C1274013) |
| Sources | AOD, COSTAR, CSP, DXP, ICD9CM, MSH, MTH, MTHICD9, MTHMST, MTHMSTFRE, MTHMSTITA, NDFRT, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
