-IBIS-1.5.0-
tx
digestive system
anal fissure
diagnoses

definition and etiology

definition:
an acute linear tear or chronic ulcer in the epithelium of the anal canal; also termed "fissure in ano" and "anal ulcer"

etiology:
The acute longitudinal fissure may be due to large bowel movements (especially of the harder stools of constipation), childbirth, iatrogenic trauma, or diarrhea. They occur most commonly in the posterior midline, and less often in the anterior.

signs and symptoms

signs and symptoms:
• acute fissures: extremely painful; worse defecation; may cause anal sphincter spasms; blood-streaked stools; may exhibit serous discharge; lower edge will normally end in a skin tag known as a "sentinel pile", and the upper end may show enlarged papilla; deep fissures may cause fibrosis and resulting stenosis
• chronic fissure: an oval or round ulcer that follows the fibrosis of a chronic infection; usually seen in the posterior midline, but occasionally appears in the anterior midline

course and prognosis

Often, the fissure will heal up with gentle care, including stool softeners, sitz baths, and topical anesthetics. If it does not, conventional physicians may perform surgery to excise the fissure. It is necessary to treat the underlying cause first, since the condition is otherwise likely to recur. One simple surgical option is partial division of the internal sphincter muscle to improve dilation.

differential diagnosis

• cancer
• primary lesions of syphilis and TB
• ulcerative colitis
• granulomatous enteritis
• hemorrhoids
• pruritus ani
• Crohn's disease
• anal sphincter stenosis


footnotes