Anal Fissure

1. Name- Avtansh Gupta
Group- 501

2. Fissure in ano(Anal fissure) is an elongated ulcer in the long axis of the lower
anal canal.
• Location
• Midline posteriorly(90%)
• Midline anteriorly

5. • Pressure of hard faecal matter on posterior anal tissues during defaecation
• Tearing down of an anal valve of Ball.
• An anterior anal fissure is much more common in females and is possibly due to
damaged pelvic floor and an attenuated perineal body in multiparous women.
• Fissure can also be due to ischemia.

6. Some causes of anal fissure are due to:
• Inflammatory bowel disease-Crohn’s
disease
• Sexually transmitted diseases
• Anal stenosis produced by excessive
excision of skin during
haemorrhoidectomy

7. Occurs in anal canal below the dentate line and hence is very painful
• Types
• Acute fissure
• Deep tear of the skin of anal margin extending into the anal canal.
• Inflammatory induration and oedema of the edges are absent
• Spasm of internal sphincter muscle
• Chronic fissure
• Inflamed indurated margins and a base consisting of either scar tissue or the lower border of internal sphincter muscle
• Presence of ‘Sentinel Pile’ at the lower end of fissure
• Spasm of internal sphincter muscle
• Infection leading to abscess or fistula

9. • More common in women
• Not uncommon in children. May lead to acquired megacolon in infancy
• Symptoms
• Pain during defaecation
• Constipation
• Bleeding per rectum
• Mucous discharge in fully established cases
• On examination
• Sentinel pile at the lower end of a linear ulcer
• Indurated edges in chronic cases

10. • Carcinoma of anal canal
• Tuberculous ulcer which has undermined edges
• Multiple fissures are seen in
• Crohn’s disease
• Homosexual practices
• Sexually transmitted diseases like herpes

11. • Aim of treatment is to obtain complete relaxation of internal sphincter. The fissure will heal
slowly.
• Conservative treatment
• Glyceryl trinitrate ointment as local application produces sufficient relaxation of internal
sphincter
• Laxatives
• Anal dilatation using dilators along with lignocaine ointment applied locally
• Operative treatment
• Lord’s anal dilatation
• Lateral anal sphincterotomy
• Dorsal fissurectomy and sphincterotomy

12. • Lord anal dilation.

13. • Lateral sphincterotomy (Closed method)

14. • Open Method