Anal Fissure

Group Members:
Bibi Goberdhan
Hakeema Figueira
Michelle Kewaroo
Zoanna Das

Objectives
To

define anal fissure.

To

identify the basic clinical

manifestation of anal fissure.

To

outline the management of anal

fissure.
To

identify the prevention of anal

fissure.

Definition
Anal

Fissure is a
longitudinal tear or
ulceration in the lining of
the anal canal usually just
distal to the dentate line.

Classifications
Acute

Anal Fissure :
Located between the anal
verge and the dentate line,
these tears may deepen to
expose the underlying
internal anal sphincter.

Chronic Anal Fissure

A fissure which fails to heal after 4
weeks is considered chronic.
- Sentinel tag
- Hypertrophic anal papilla
- Induration of the edge of the
fissure
- Fibrosis of the exposed internal
anal sphincter fibers
- Relative stenosis secondary to
spasm

INCIDENCE OF
CONDITION
Anal

fissures can occur in any

age group .Most cases occur in
children and young adults
between the ages of 10 and 30.

Found

in equal frequency in
males and females.

ETIOLOGY
Fissures are usually caused by:
the trauma of passing a large,
firm stool
from

persistent tightening of the

anal canal because of stress and
anxiety (leading to
constipation).

 Other

causes include childbirth, trauma,

and the overuse of laxatives , straining
during defecation, prolonged diarrhea,
pregnancy, or inflammatory bowel
disorders such as Crohn's disease
(Etzioni,2011).

Less

common causes of anal fissures in

adults include anal sex and diseases
such as cancer, HIV, tuberculosis, and
syphilis.

Risk Factors
Diets

low in fiber and water

Caffeine
Spicy

foods may aggravate symptoms

of anal fissures.

 Other

risk factors in adults include

harsh anal hygiene (rough toilet
paper), chronic wetness around the
anus, rectal irritation, sexual abuse,
and inflammatory bowel disorders
such as Crohn's disease.

CLINICAL MANIFESTATIONS

Anal

bleeding.

Pain
Itching

in the anal area is reported.

Dysuria

TREATMENT - Medical
Treatments

to reduce sphincter
spasm and promote healing of
fissures include:
1. Injecting the sphincter with
botulinum toxin and applying GTN
ointment or CCB to the area of the
fissure.
2.

A stool softener eg. Zoloft

Surgical Managment Chronic

Sphincter
Lateral
Anal

Dilatation

Internal Sphincterotomy

Fissurectomy

DIAGNOSTIC EVALUATION

Physical Assessment

Rectal

Examination

Anoscopy

/ Flexible Sigmoidoscopy

COMPLICATIONS
Some

of the possible complications of an

anal fissure include:

Chronic

Anal fissure

Anal

fistulas

Anal

stenosis

PATIENT EDUCATION
PREVENTION

Fissures!

Of Anal

Reference
Hinkle

Janice, Cheever Kerry. Bunner & Suddarths: Textbook of Medical-Surgical

Nursing 13th edition,Printed in China. Lippincott Raven Publishers.2014

Ignatavicius

Donna, Workman Linda. Medical surgical Nursing: Patient-Centered

Collaboration Care. 6th Edition. United States of America. Saunders Elsevier Ins.

Schoen,

D. C. (2000). Adult Orthopaedic Nursing. Philadelphia: Lippincott.

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and what to do about them - Harvard Health. (n.d.). Retrieved July

22, 2016, from http://www.health.harvard.edu/diseases-andconditions/hemorrhoids_and_what_to_do_about_them

Thornton,

S. C. (n.d.). Hemorrhoids. Retrieved July 22, 2016, from

http://emedicine.medscape.com/article/775407-overview

Anal

fissure. (n.d.). Retrieved July 22, 2016, from http://www.bupa.co.uk/healthinformation/directory/a/anal-fissure