1. Fissure in ano

2. 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

3. #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

4. # diagnosis
DRE
Proctoscopy
contraindicated

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

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

7. Acute anal fissure