Anl Fissures

Anl Fissures
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Anal Fissure


http://www.rasoulazizi.com/images/fissures-colorectal-diseases%20%281%29.png                   Anal Fissure is a Colorectal Diseases                     

               

 


Anal Fissure

Early, or acute, fissures have theappearance of a simple tear in the anoderm, whereas chronic fissures, definedby symptoms lasting more than 8-12 weeks, are further characterized

by edema and fibrosis. Typicalinflammatory manifestations of chronic fissures include a sentinel pile, orskin tag, at the distal fissure margin and a hypertrophied anal papillaproximal to the fissure in the anal canal.

Trauma to the anal canal secondaryto the passage of a hard stool is believed to be a common initiating factor. Ahistory of constipation is not universally obtained, however, and some patientsreport an episode of diarrhea before the onset of symptoms.

The clinical hallmark of an analfissure is pain during, and particularly after, defecation. In acute fissures,pain may be short-lived, but it can last several hours or even all day in the

presence of a chronic fissure. Thepain is frequently described as passing razor blades or glass shards.Understandably, patients with anal fissures may often fear bowel movements.

Rectal bleeding, although notuncommon, is usually limited to minimal bright red blood seen on the toilettissue.

Fissures may be frequentlymisdiagnosed as hemorrhoids by primary care providers. The differentialdiagnosis includes perianal abscess, anal fistula, inflammatory bowel disease,

sexually transmitted disease,tuberculosis, leukemia, and anal carcinoma.

Conservative management

Almost half of all patientsdiagnosed with an acute fissure will heal with conservative measures, i.e.,sitz baths and psyllium fiber supplementation, with or without the addition oftopical anesthetics or anti-inflammatory ointments.

Operative Treatment

The primary goal in the treatment ofa nonhealing anal fissure is to decrease abnormally elevated resting anal tone.

Operative procedures, such as manual anal dilatation or internal sphincterotomy,have been advocated as initial modes of treatment because they produce permanentreductions in maximum

resting anal pressures.

Lateral Internal Sphincterotomy

The use of internal sphincterotomyin the treatment of anal fissure was introduced by Eisenhammer in the early1950s.

Medical Management

Sphincter Relaxants

"chemical sphincterotomy,"aimed at reducing mean maximum resting anal pressures, without permanentsphincter injury. Preparations have included: 

various nitrate formulations,including nitroglycerin (NTG) ointment, glyceryl trinitrate (GTN), andisosorbide dinitrate (ISDN) oral and topical calcium channel blockers,including nifedipine

and diltiazem (DTZ) and botulinumtoxin (BT). Botulinum Toxin (BT) is an exotoxin produced by thebacteriumClostridium botulinum. BT injections can be given easily, on anoutpatient basis,

and are well tolerated. Thecommercial availability of BT has prompted several prospective trials examiningits efficacy in the treatment of anal fissure

 

 

 

 

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