Anal Fissure Tóm tắt về bệnh

Tổng quan

As stated in the Introduction section, an anal fissure is a linear tear within the anal canal usually extending from the dentate line toward the anal verge.

Anal fissures commonly occur in younger and middle-aged adults, with a peak incidence occurring between 15-40 years of age. Other details regarding its prevalence are found in the Epidemiology section.

The Pathophysiology section states that anal fissures typically start at the anoderm, wherein it triggers cycles of pain bleeding. This in turn leads to the development of chronicity in about 40% of individuals affected.

The Etiology section discusses the common causes of anal fissures such as passage of hard stools, explosive diarrhea, childbirth via vaginal delivery, anal intercourse, and even anorectal surgery.

The Classification section divides anal fissures into acute and chronic based on time and clinical features.

Anal Fissure_Disease Summary

History and Physical Examination

The History section lists the common symptoms of anal fissures such as anal pain that is often present at rest but severe during bowel movement; with patients describing the process of defecation as passing razor blades. The Physical Examination section describes confirmatory findings observed in the physical exam.

Chẩn đoán

Other conditions that should be ruled out in the diagnosis of anal fissures are listed in the Differential Diagnosis section.

Xử trí

The Evaluation section lists other diagnostic examinations that can be performed when the fissure/s are not readily seen.

As mentioned in the Principles of Therapy section, diet modification and medical therapy constitute the initial treatment for anal fissures. The goals of therapy are also discussed in this section.  

The Pharmacological Therapy section discusses in detail the different first-line and second-line agents such as calcium antagonists, nitrates, botulinum toxin injection, muscarinic agonists, and adrenergic antagonists.

The Nonpharmacological section discusses other measures like diet modification with a high-fiber diet and supplementation, sitz baths, and even the use of mineral oil.

As mentioned in the Surgery section, surgery remains the gold standard of therapy for chronic anal fissure. This section also details the different surgical interventions for anal fissure such as advancement flaps, fissurectomy, and lateral internal sphincterotomy (LIS).