Tuesday, December 9, 2014

Anal Fissure


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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