Updated: 6/11/2021

Anal Fissures

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Topic
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Topic
Snapshot
  • A 45-year-old man has severe rectal pain when he defecates. He reports the stool is covered with bright red blood. A sentinel pile is noted on physical exam.
Introduction
  • Tear or fissure in anal epithelium
  • Can occur at any age
  • Caused by
    • irritating diarrhea
    • hard stool
    • disease process (Crohn's, STDs, ulcerative colitis, and AIDS)
  • Leads to tightening of anal canal related to nervous tension
Presentation
  • Symptoms
    • severe rectal pain on defecation
    • bleeding
    • anal tenderness
Evaluation
  • Anoscopy
    • anal tag indicates location
    • hypertrophied papilla is noted above the fistula.
Treatment
  • Medical
    • nitroglycerine ointment
    • botox
  • Surgical
    • in refractory cases

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