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Understanding Anal Fissures: Causes & Treatments

The document discusses anal fissures, including their symptoms, causes, and various treatment options. It describes the location and features of acute versus chronic fissures. Warm baths and a high fiber diet can help acute fissures heal in 50% of cases within 3 weeks. Topical treatments like nitroglycerin can also aid healing, while chronic fissures may require procedures like lateral internal sphincterotomy.

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grace liwanto
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49 views13 pages

Understanding Anal Fissures: Causes & Treatments

The document discusses anal fissures, including their symptoms, causes, and various treatment options. It describes the location and features of acute versus chronic fissures. Warm baths and a high fiber diet can help acute fissures heal in 50% of cases within 3 weeks. Topical treatments like nitroglycerin can also aid healing, while chronic fissures may require procedures like lateral internal sphincterotomy.

Uploaded by

grace liwanto
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

ANAL FISSURE

INTRODUCTION

• Fissure is a tear in the anal canal extending from


just below the dentate line to the anal verge.

• Most commonly in young and middle age adults.

• The cardinal symptom is pain during and for


minutes to hours following defecation.

• Bright red blood is common


INTRODUCTION

• Over 90% of anal fissures are located in the


posterior midline.

• Almost all the rest located in the anterior midline.

• The acute fissure is a "mere crack" in the anoderm.

• Distal sentinel tag, a proximal hypertrophied anal


papilla, fibrotic edges, and exposed internal
sphincter fibres are features of chronicity
Etiology and Pathogenesis

• The initiating factor is trauma, typically overstretching of the


anoderm by a large hard stool.

• Posterior midline : lack of tissue support and maximal


stretching

• Failure to heal : poor perfusion at posterior midline.

• Posterior midline ischaemia is the result of arterial anatomy


and internal anal sphincter hypertonicity.
Treatment

• Warm baths and a diet sufficiently high in fibre to


achieve soft bulky stools allows approximately 50%
of acute anal fissures to heal within three weeks.

• Stool softeners and fibre supplements are


reasonable additions.

• Recurrence is common, in the range of 30 - 70%,


but can be reduced to 15 - 20% by maintaining a
high fibre diet
Acute Fissure
Topical Application
• Nitric oxide mediating relaxation of the internal anal
sphincter.

• Topical application of nitroglycerin, a nitric oxide donor,


causes a transient lowering of resting anal pressure and an
increase in anodermal blood flow.

• 0.2% glyceryl trinitrate ointment t.i.d  92% healing rate


within two weeks for acute fissures. n/a for pregnant or
lactating women
Acute Fissure
Topical Application
• Topical calcium channel blockers (2% diltiazem, 0.3% nifedipine) .

• Heal 65-95% of fissures .

• The most common side effects are


headache, flushing, and symptomatic
hypotension.
Treatment
Chronic Fissure
• Topical Nitroglycerin: At eight weeks healing was observed in 68%

• Botulinum Toxin: Botulinum toxin has been injected into the external
and internal sphincters and, with short term follow up, healing rates
of 80% have been achieved.
Treatment
Chronic Fissure

• Are unlikely to heal with warm baths and a high fibre diet.

• Internal Sphincterotomy : Lateral internal sphincterotomy (LIS)


achieves healing in over 95% within several weeks

• Anal Dilatation

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