| ID | 239 |
|---|---|
| Name | ANAL FISSURE |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | |
| Introduction | This is a split of the anal canal, usually in the midline posteriorly but also occuring in the midline anteriorly. Anal fissure may be-A. Acute, or B. Chronic in type. |
| History | |
| Etiology | Etiology: Cause of anal fissure is unknown; but it is usually due to the- 1. Passage of hard stool 2. Hemorrhoidectomy 3. Injury during child birth |
| Clinical Features | Clinical features: 1. Excruciating pain during and after defecation. 2. Some patient complaints of constipation. 3. Stool may be streaked with blood. 4. There may be some discharge and pruritus ani. On examination: A. Inspection: The anus appears puckered. Sentinel skin tag may be seen. With gentle traction of perianal skin the fissure may be seen as a triangular slit. Fibrosis and induration is present in ch. cases. There may be perianal abscess behind the fisssure, spasm of anal sphincter may disallow rectal examination. B. Proctoscopy: Usually not done. If required, button-hole appearence may be seen. |
| Preventions | |
| Treatment | Treatment: Acute & Superficial: 1. Sedation. 2. Regulation of bowel habit with- i. high fibre diet, ii. stool softeners e.g liquid paraffin, castor oil, milk of magnesia iii. plenty of water. 3. Local analgesic- cream or ointment preparations are available to relieve pain and apasm. 4. Digital dilatation under local anesthetic (xylocaine 5% solution). 5. Glyceryl trinitrate (GTN) 0.2% cream applied 4 times daily; Or, diltiazeme 2% cream applied twice daily- usually curative. Operative treatment: Stretching of the sphincter under general anesthesia is curative for about 85% cases. Internal sphincterotomy or excision of fissure is indicated if stretching fails or if there is marked induration at the base of the ulcer. |
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