ANAL FISSURE
This
is the most painful anorectal
condition. It occurs
most
commonly in the
posterior quadrant at the anal verge due
to a
linear
tear of an anal valve. It makes a
posterior (ear is
common, in females anterior tears are
seen more often.
The cause is unknown but it is
suspected that constipation plays
a role.
The
pain of anal fissure results primarily from sphincter spasm
which is stimulated by the exposed
nerve endings in the infected
ulcer
bed. Severe pain and tenderness often
render PR and
proctoscopy examination difficulty.
TREATMENT
CONSERVATIVE MANAGEMENT
Conservative Management
is required in superficial
fissure of
recent
origin (acute fissure), local
application of 2.5 or 5%
xylocaine ointment, before bowel
movements.
*
Sitz baths two or
three times daily. Laxative
or stool
softener.
*
Injections of a local anaesthetic
agent with a gloved index
finger of the left hand on the anal canal after application of
5% xylocaine jelly to the fissure.
*
The needle is passed behind the
lining of anal canal to the
level of the fissure and local anaesthetic in oil is injected.
*
This provides immediate relief of pain.
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