Anal fissure: Difference between revisions
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*In >90% of cases anal fissures occur in the midline posteriorly | *In >90% of cases anal fissures occur in the midline posteriorly | ||
**Nonhealing fissure or one not located in midline suggests alternative dx | **Nonhealing fissure or one not located in midline suggests alternative dx | ||
==Clinical Findings== | ==Clinical Findings== | ||
*Acute sharp, cutting pain most severe during and immediately after bowel movement | *Acute sharp, cutting pain most severe during and immediately after bowel movement | ||
**Subsides between bowel movements (distinguishes fissure from other anorectal disease) | **Subsides between bowel movements (distinguishes fissure from other anorectal disease) | ||
*Bright red bleeding, small in quantity (usually noticed only on toilet paper) | *Bright red bleeding, small in quantity (usually noticed only on toilet paper) | ||
==Diagnosis== | ==Diagnosis== | ||
*Having pt bear down may make fissure more noticable | *Having pt bear down may make fissure more noticable | ||
*Sentinel pile, located at distal end of fissure, along w/ deep ulcer suggests chronicity | *Sentinel pile, located at distal end of fissure, along w/ deep ulcer suggests chronicity | ||
**Often misdiagnosed as an external hemorrhoid | **Often misdiagnosed as an external hemorrhoid | ||
==DDX== | ==DDX== | ||
#Crohn disease | #Crohn disease | ||
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#Perianal abscess | #Perianal abscess | ||
#Intersphincteric abscess | #Intersphincteric abscess | ||
==See Also== | |||
*[[Anorectal Disorders]] | |||
==Source== | ==Source== | ||
Revision as of 17:33, 15 November 2011
Background
- Superficial linear tear of anal canal from at/below dentate line to anal verge
- May be due to passage of hard stool, frequent diarrhea, or abuse
- Most common cause of painful rectal bleeding
- In >90% of cases anal fissures occur in the midline posteriorly
- Nonhealing fissure or one not located in midline suggests alternative dx
Clinical Findings
- Acute sharp, cutting pain most severe during and immediately after bowel movement
- Subsides between bowel movements (distinguishes fissure from other anorectal disease)
- Bright red bleeding, small in quantity (usually noticed only on toilet paper)
Diagnosis
- Having pt bear down may make fissure more noticable
- Sentinel pile, located at distal end of fissure, along w/ deep ulcer suggests chronicity
- Often misdiagnosed as an external hemorrhoid
DDX
- Crohn disease
- Often painless
- Squamous cell carcinoma of anus
- Adenocarcinoma of rectum invading the anal canal
- Syphilitic fissure
- GC/Chlam
Treatment
- Hot sitz baths 15 min TID-QID and after each bowel movement
- Provides symptomatic relief and relieves anal sphincter spasm
- High-fiber diet
- Prevents stricture formation by providing a bulky stool
- Local analgesic ointments with hydrocortisone
- Meticulous anal hygiene is imperative; after defecation anus must be cleaned thoroughly
- Surgical referral indicated if healing does not occur in a reasonable amount of time
Complications
- Perianal abscess
- Intersphincteric abscess
See Also
Source
Tintinalli