Anal Fissures

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These  are  painful  linear  ulcers  in  the  anal  canal.  Young  and  middle-aged  adults  most  affected.  Primary fissure occurs in the posterior midline. It can also be secondary to Crohn’s disease, anal  cancer, or infection such as syphilis, TB in which case they occur more lateral. Passage of hard  stools is a common predisposition to primary fissures. 

Clinical presentation 

• Severe sharp pain during and after defecation with/out bright red bleeding.

Investigations 

• Evidence of linear anal rectal ulceration on proctoscopy examination

Non-Pharmacological Treatment 

• Ensure high fluid intake

Pharmacological Treatment 

• Topical anesthetics and frequent seat baths can reduce sphincter spasm (should be offered before surgery)
• Use non stimulant osmotic laxatives

Surgery: Surgical sphincterotomy is definitive treatment.