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.
