FISSURE IN ANO

This is an elongated longitudinal ulcer of the lower anal canal. The commonest site is the midline posteriorly, followed by midline anteriorly.

Clinical Features

This condition occurs in children, but is more common in females in their midlife.
It is uncommon in the elderly.

  • The affected individual experiences pain during defecation that is often intense, may last for an hour or more, but subsides only to come again during the next defecation.
  • The patient is reluctant to open bowels because of the pain and tends to be constipated. The stool is frequently streaked with fresh blood and a slight discharge occurs in chronic cases.
  • A sentinel tag is usually demonstrated, with a tightly closed puckered anus.
  • Digital rectal examination and proctoscopy are painful, and can be performed at examination under anaesthesia (EUA).

It is important to consider carcinoma of the anus, anal chancre, tuberculosis ulcer (whose edges are undermined), and proctalgia fugax as important differential diagnoses that must be ruled out.

Management

  • Anaesthetic + anti-inflammatory ointments (3–4 times a day) or suppositories may be tried. Avoid use for more than 1 week consecutively.
  • Some heal spontaneously
  • Stool softeners, diet, saline sitz bath
  • Operative treatment is recommended for cases refractory to conservative treatment