Category - Anal
Anal fissure last revised in january 2017 next planned review by december 2021. An anal fissure is a tear or ulcer in the lining of the anal canal, immediately within the anal margin. Lidocaine is the most commonly prescribed topical anaesthetic for anal fissures. It comes in the form of either a gel or an ointment, and is usually only used for 1 to 2 weeks because the fissure should start to heal within this time. An acute anal fissure appears as a fresh laceration, while a chronic anal fissure has raised edges exposing the internal anal sphincter muscle fibres underneath. Chronic anal fissures are also often accompanied by an external skin tag (sentinel pile) at the distal end of the fissure and a hypertrophied anal papilla at the proximal end (difficult to see on physical examination) ( fig.). Chronic anal fissure limited evidence suggests that the strength used does not influence the effectiveness, but that the higher strength potentially increases the incidence of side-effects. Healing rates with topical glyceryl trinitrate are marginally superior to placebo, but the incidence of headache as an adverse effect is quite high (about 20-30 of patients). common topical anal preparations include local anaesthetics, steroids and antibiotics. Most successful formulations include all three in various combinations. They are useful for acute conditions such as thrombosed external haemorrhoid or acute fissure, but prolonged use should be discouraged. When someone has an anal fissure the first treatments can include a high-fibre diet, laxatives and applying anaesthetic ointments to the affected area. Anal fissures usually heal within a few weeks but those that have not healed after 46 weeks are called chronic fissures.