Anal fissure: Difference between revisions
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#Hot sitz baths 15 min TID-QID and after each bowel movement | #Hot sitz baths 15 min TID-QID and after each bowel movement | ||
##Provides symptomatic relief and relieves anal sphincter spasm | ##Provides symptomatic relief and relieves anal sphincter spasm | ||
#Topicals | |||
##Pain control with lidocaine | |||
##Vasodilators such as nitroglycerin ointment | |||
##Hydrocortizone | |||
#High-fiber diet | #High-fiber diet | ||
##Prevents stricture formation by providing a bulky stool | ##Prevents stricture formation by providing a bulky stool | ||
#Meticulous anal hygiene is imperative; after defecation anus must be cleaned thoroughly | #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 | #Surgical referral indicated if healing does not occur in a reasonable amount of time | ||
Revision as of 15:25, 5 January 2015
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)
- Lateral to anus often indicates associated systemic illness such as Crohns, HIV, Leukemia, TB, syphillis
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
Differential Diagnosis
- Crohn Disease
- Often painless
- Squamous cell carcinoma of anus
- Adenocarcinoma of rectum invading the anal canal
- Syphilitic fissure
- GC/Chlam
Anorectal Disorders
- Anal fissure
- Anal fistula
- Anal malignancy
- Anal tags
- Anorectal abscess
- Coccydynia
- Colorectal malignancy
- Condyloma acuminata
- Constipation
- Crohn's disease
- Cryptitis
- GC/Chlamydia
- Fecal impaction
- Hemorrhoids
- Levator ani syndrome
- Pedunculated polyp
- Pilonidal cyst
- Proctalgia fugax
- Proctitis
- Pruritus ani
- Enterobius (pinworms)
- Rectal foreign body
- Rectal prolapse
- Syphilitic fissure
Non-GI Look-a-Likes
Treatment
- Hot sitz baths 15 min TID-QID and after each bowel movement
- Provides symptomatic relief and relieves anal sphincter spasm
- Topicals
- Pain control with lidocaine
- Vasodilators such as nitroglycerin ointment
- Hydrocortizone
- High-fiber diet
- Prevents stricture formation by providing a bulky stool
- 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