Fissure in ano

Introduction Pathogenesis A linear ulcer (tear) of the lower half of the anal canal Pathogenesis Exact cause is unknown Probably due to mucosal ischaemia secondary to muscle spasm Large, hard stool 5% associated with chronic intersphinteric abscess

#CLINICAL FEATURES --Features of chronicity: Pain on defecation, bright red bleeding pruritus ani --Features of chronicity: Symptoms for more than 6 weeks Papilla Undermined edges Visible internal sphincter

# diagnosis DRE Proctoscopy contraindicated

MANAGEMENT a)medical management Stool softeners, bulking agents, sitz baths, topical local anesthesia Topical nitroglycerin (0.2% GTN) or nifedipine Botulinum toxin

b)surgical management Lateral sphincterotomy Lord’s dilatation (anal stretch procedure) Fissurectomy & local advancement flap

Acute anal fissure