Anal Fissure

An anal fissure is a tear in the anal mucosa that can cause severe anal pain and rectal bleeding and results from local stool trauma. Most occur posteriorly in the midline. Other causes or locations should prompt a more complete ano-rectal evaluation. On examination, the anus is exquisitely tender and may demonstrate internal anal sphincter spasm. Evaluation can occur with gentle spreading of the anus, but some require anoscopy to assess their extent. A radial tear is seen that can be bleeding and very tender.

Most acute anal fissures can be managed conservatively with dietary fiber, prevention of constipation, adequate hydration, and stool softeners. Sitz baths may provide symptomatic improvement. Topical anesthetics such as 5% lidocaine ointment or gel can be used for comfort or before defection until healing. No surgical treatment is warranted in uncomplicated occurrences. Chronic anal fissures do not resolve after the 3-month acute phase and are generally less tender. Chronic fissures are still associated with significant internal sphincter spasm and may present with a large, protuberant sentinel tag, sometimes confused with a hemorrhoidal tag.

Conservative therapy includes continued constipation prevention. Other therapeutically equal treatment options include topical nitroglycerin ointment, botulinum toxin injections, or calcium channel blockers such as diltiazem or nifedipine for 30 days. However, no conservative medical therapy approximates the efficacy of surgical sphincterotomy for chronic fissures (Nelson, 2006). An open or closed partial lateral internal sphincterotomy appears to be equally efficacious as surgical treatment (Nelson, 2008). An experienced specialist in the technique and anorectal anatomy should perform this procedure.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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