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Anal Fissura
Anal Fissura
Anal Fissura
DEFINITION
• A Hemorrhoidal Condition
• Irritation Due To Diarrhea
• Partus Injury
• Crohn Disease
• Constipation
• Inflammatory Bowel Diseases
• Sexually Transmitted Diseases
• Anal Cancer
Symptoms
when the stool passes through the anal canal, the mass
will be channeled to the anterior & posterior parts due to
the presence of muscles in the lateral part.
In acute fissura ani → ulcers appear firmly bound,
there is no induration, odema or cavitation.
In chronic fissura ani → visible edge of the ulcer
induration & if the process the ulcer continues to
expand and the outside looks odematous because
of lymphatic obstruction, skin tags & anal papilla
hypertropy can be found under the circumstances
fissura ani chronic.
DIAGNOSIS1
1. Anamnesis
• Inspeksi
On inspection often found skin tags, fissures, and papilla hypertrophy
The examination is doing by slowly pulling both buttocks to see if there are
skin tags, discharges or blood.
• Palpation
The margins of fissura can be palpable irregular, tenderness (+). The direct
examination on fissura is very painful
• Proctoscopy / Sigmoidoscopy
The use of adult protoscop in acute circumstances is usually indispensable
probably done because of very pain. Usually using infant sigmoidoscopy
Llyod-Davies can be seen abnormalities in the rectal & anal mucosa canal.
3. supporting examination
Crohn's Disease
Ulcerative Colitis
Tuberculous Anal Fissures
Syphlitic Fissures
Intersphincteric Abscess
Malignancy
Ani Pruritus
AIDS
Proctalgia Fugax
MANAGEMENT
Advise the patient to increase dietary fibre and fluid intake to keep
bowel motions soft
The importance of correct anal hygiene and the need to keep the anal
area dry should be emphasised.
Regular sitz baths (sitting in warm water up to the hips) can help to relax
the sphincter.
The patient should also be advised to avoid undue straining during
bowel movements.
If lifestyle and dietary interventions are insufficient, or if the fissure is
severe, a stool softener, e.g. oral docusate sodium, and mild local
analgesia, e.g. lidocaine (not subsidised), may be prescribed.
If the fissure fails to heal within three to six weeks, topical nitrates or
topical calcium channel blockers should be used. All topical
treatments for anal fissures should be applied for at least six weeks to
allow re-epithelialisation of the fissure
If the fissure has not healed after six to eight weeks of topical treatment
and dietary changes secondary care to assess the appropriateness of
other treatments, usually botulinum toxin or surgery.
Surgical techniques commonly used for anal fissures which aim to relax
the internal sphincter include; open lateral sphincterotomy, closed
lateral sphincterotomy and posterior midline sphincterotomy.