Anal fissures

• What are anal fissures?

  Longitudinal or elliptical tears of the squamous lining of the distal anal canal
• What is the cut off for acute anal fissures?

  Present for <6 weeks
• What are some risk factors for anal fissures?

  Constipation

  IBD

  STIs
• What are some features of anal fissures?

  Pain

  Bright red rectal bleeding
• What % of anal fissures occur on the posterior midline?

  90%
• How are acute anl fissures managed?

  Soften stool

  Lube before defecation

  Analgesia

  Topical anaesthetics
• How is chronic anal fissures managed?

  Topical GTN + management for acute
• What is the first line treatment for chronic anal fissures?

  Topical GTN
• What happens if topical GTN is not effective after 8 weeks?

  Surgery - sphincterotomy or botox
• What does a lateral anal fissure suggest?

  Secondary cause and requires further investigation