Anal Fissure
Pt p/w tearing pain at rectum during defecation, rectal bleeding, and a linear tear noted at the posterior midline of the rectum. Bleeding is bright red and small in quantity.
Symptoms have lasted less than 6 weeks. Pt is immunocompetent. Unlikely NAT, autoimmune, or malignant causes of the fissure. Plan WASH regimen: warm water- sitz baths for 15 minutes three times daily, anesthetic- topical lidocaine, stool softener, and high fiber diet and DC home.
Symptoms have lasted less than 6 weeks. Pt is immunocompetent. Unlikely NAT, autoimmune, or malignant causes of the fissure. Plan WASH regimen: warm water- sitz baths for 15 minutes three times daily, anesthetic- topical lidocaine, stool softener, and high fiber diet and DC home.
Chronic repetitive or >6weeks of Anal Fissure
Pt p/w tearing pain at rectum during defecation, rectal bleeding, and a linear tear noted at the posterior midline of the rectum. Bleeding is bright red and small in quantity.
Symptoms have lasted more than 6 weeks. Unlikely NAT. Refer to surgery for biopsy of the ulcer edge, culture of the anal canal, and a systemic evaluation for autoimmune or malignant causes of the fissure.
Symptoms have lasted more than 6 weeks. Unlikely NAT. Refer to surgery for biopsy of the ulcer edge, culture of the anal canal, and a systemic evaluation for autoimmune or malignant causes of the fissure.
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Tintinallis Emergency Medicine A Comprehensive Study Guide 8th Edition p 550
- A Chronic non healing fissure, lasting more than 6 weeks, or one not located in the midline should arouse suspicion for Crohn’s disease, chronic ulcerative colitis, squamous cell carcinoma of the anus, adenocarcinoma of the rectum invading the anal canal, localized anal cancers such as Bowen’s disease and extramammary Paget’s disease, leukemia, lymphoma, syphilitic fissures, chlamydia, gonorrhea, human immunodeficiency virus, and a tuberculous ulcer. Or ABUSE
- Consideration of these diagnoses requires referral for diagnostic biopsy of the ulcer edge, culture of the anal canal,and a systemic evaluation.
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If patient having serious pain during exam, digital rectal examination can be deferred until the patient is having less spasm and pain
Instruct patient if healing does not occur within 6 weeks or relapses are frequent, surgical referral is recommended.
Ultimately will heal on its own or need surgery medical therapies are no better than placebo.
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