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Anal Fissures

Description

An anal fissure is a tear in the lining of the anus. It can be acute (<6 weeks) or chronic (>6 week).

Anal Canal

Cause

Most fissures arise without any underlying disease but can be associated with Crohns disease. They can occur as a result of chronic constipation, passing hard, large stools, repeated episodes of diarrhoea, trauma to the anus or anal canal, childbirth, or reduced blood flow to the anorectal area.

Symptoms

Anal fissures usually cause severe anal pain and bright red bleeding on defaecation. As a fissure becomes chronic, a perianal lump may be felt. Constipation is common but not always present.

Diagnosis

This is usually made from the classic history and by simple inspection of the perianal area

Treatment

Acute Anal Fissure

These heal with simple measure such as stool softeners eg movicol and dietary modifications (increasing fibre). Rectogesic (0.2% GTN) can help to ease symptoms and heal the fissure. Simple hygiene measures such as baby wipes are used to keep the area clean

Chronic Anal Fissure

These fissures are unlikely to heal with conservative measures alone although they should be continued. All treatment options involve measures to relieve anal sphincter spasm in order to allow healing. Options of treatment include:

  • Topical agents – Rectogesic (GTN 0.2%) ointment is applied to the area three times per day. A gloved finger is used to apply a pea-sized portion of cream to the anal verge and to 1cm into the anal canal. The most common side effect is headache. This symptom usually subsides after 24 hours of use. An alternative that causes fewer headaches is Nifedipine ointment (0.3%). Creams are effective in healing a fissure in up to 50%.
  • Botox injection – Healing rates in 50 – 70% of cases??
  • Lateral Sphincterotomy – Healing rates > 95%

Recurrent and Persistent Anal Fissures

In a small amount of cases, a fissure persists or recurs despite the above treatment. In such cases it is important to exclude other diseases such as Crohns. Usually an endoanal ultrasound is performed and anal pressures are measured. Options include further botox, a repeat lateral sphincterotomy or an anal advancement flap.

  • Prince of Wales Private Hospital
  • The Royal Hospital For Women Foundation
  • Colorectal Surgical Society of Australia and New Zealand
Randwick Rooms

Prince of Wales Private
Suite 17, Level 7
Barker Street
Randwick NSW 2031

Phone: 1300 553 347
Fax: (02) 9650 4924

Double Bay

Double Bay Day Hospital Specialist Suites
Suite 3.01, Level 3, commercial
451 New South Head Road
Double Bay

Phone: 0290 863 133
Fax: (02) 9086 3123

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