Fissure in ano

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Fissure in ano
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• Definition
• An anal fissure is a longitudinal crack in the
  wall of the anal mucosa so that the circular
  muscle layer is exposed.
• The tear usually occurs directly posteriorly and
  in the midline.
• Incidence
• Men women
• The peak incidence 20-30 year
• Aetiology
• The precise etiology is unknown

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• An anal fissure may be produced secondary to
  inflammatory bowel disease, especially Crohn's,
• A traumatic laceration from a hard or large
  stool, with secondary infection.
• Pathophysiology
• Fissure rests on the internal sphincter and
  causes it to spasm, which interferes with blood
  supply and thus perpetuates the fissure.

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• Symptoms, Signs, and Diagnosis
• Acute fissures usually lie in the posterior
  midline
• but may occur in the anterior midline.
• An external skin tag (the sentinel pile) may be
  present at the lower end of the fissure, and
• an enlarged (hypertrophic) papilla may be present
  at the upper end.
• Infants may develop acute fissures.
• Pain
• Bleeding during defecation.
• The pain typically occurs with or shortly after
  defecation, last for several hours, and subsides
  until the next bowel movement.
• Examination must be gentle spreading apart the
  anus may reveal the fissure in its midline
  location.

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• Differential diagnosis
• Chronic fissures must be differentiated from
  several disorders
• cancer,
• primary lesions of syphilis,
• TB,
• Crohn's

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• Treatment
• Fissures often respond to conservative measures
  that minimize trauma during defecation (eg, stool
  softeners, bulking agents).
• Healing often results from use of bland
  suppositories (eg, glycerin) that melt, lubricate
  the lower rectum, and act as an emollient.
• Sitz baths for 10 or 15 min after each bowel
  movement
• Topical nitroglycerin 0.2 relaxes the anal
  sphincter and drops the maximum anal resting
  pressure.
• Surgery is needed to interfere with the cycle of
  internal anal sphincter spasm, which is commonly
  accomplished by internal anal sphincterotomy or
• controlled anal dilation.

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