Anal Fissures!

Exciting topic:  Anal Fissures!

Definition:  Tear in the anorectal dermal tissue, usually at the posterior “6 o’clock” position where the anorectal muscle come together

Hx:  Patient presents with sudden onset rectal pain with small amount of bleeding

PE:  Usually posterior tears, but if tear occurs at any other position consider comorbid conditions such as IBD and HIV.  Chronic fissures may turn into a “Sentinel Pile”  which is a small skin tag.

Treatment Teaching Point:  Rectiv is a Nitroglycerin 0.4% ointment apply BID to TID in addition to SITZ baths and stool softener.  Referral to a surgeon for botox injection is also a treatment option.  If left untreated these can become chronic and cause fecal incontinence.

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