Anal Fissures
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Introduction
Crack or tear in the anoderm
90% are in the posterior midline, 10% in the anterior midline
sentinel skin tag
hypertrophied anal papilla: skin tag on inside
The Case of...
Causes and Risk Factors
Most are idiopathic, but can also be associated with serious conditions
Pathophysiology
Higher anal sphincter tone is associated with anal fissures, though it is not clear which occurs first
Signs and Symptoms
- history
- physical exam
History
Bright red blood seen with bowel movements, commonly on the toilet paper
Pain with
Physical Exam
Fissures are a visual diagnosis
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Lateral fissures of the midline should raise suspicion of something else:
- Crohn's
- malignancy
- infection (ie STI)
Differential diagnosis includes:
- pruritus ani
- IBD
- tuberculosis
- AIDS
- sexual abuse
Treatments
Lifestyle measures
High-fibre stools to soften stool
Hot tub soaks
Medications
Medical management is aimed at relaxing the interior anal sphincter, which is composed of smooth muscle
- topical calcium channel blockers
- nitroglycerin
- botox
Surgery
Lateral internal sphincterotomy, with a low risk of incontinence
Consequences and Course
The Case of...
Additional Resources
Topic Development
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