ANAL FISSURE

14. What is the most common location for idiopathic anal fissure?

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90% are posterior, and 10% are anterior.

15. What are the most common symptoms of anal fissure?

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Tearing anal pain and bleeding with bowel movements.

16. What is the underlying pathophysiology of fissure in ano?

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Local trauma to the anal canal, internal anal sphincter dysfunction, and ischemia.

17. What is the differential diagnosis for anal fissure, especially if atypical in location?

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Anorectal abscess, thrombosed hemorrhoid, inflammatory bowel disease, or malignancy.

18. How do you best diagnose anal fissure?

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By clinical history and visual inspection-not by digital examination or anoscopy (which serves only to turn a friendly patient into an irate one).

19. What are the nonoperative treatment options?

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High-fiber diet; stool-bulking agents; increased hydration; frequent, warm sitz baths; and topical agents containing anti-inflammatory agents, local anesthetics, and vasodilators (nitroglycerin).

20. What is the most common operation performed to treat intractable fissure in ano?

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Fissurotomy with lateral internal anal sphincterotomy.
KEY POINTS: ANAL FISSURE

1. Ninety percent of idiopathic anal fissures are posterior and 10% are anterior.
2. The most common symptoms are tearing anal pain and bleeding with bowel movements.
3. The diagnosis involves visual inspection-not by digital exam or anoscopy.
4. Nonoperative treatment includes high-fiber diet, warm sitz baths, and topical agents containing anti-inflammatory agents, local anesthetics, and vasodilators.
5. The most common operation is a fissurotomy with lateral internal anal sphincterotomy.