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Encyclopedia > Anal fissure
Anal fissure
Classification & external resources
ICD-10 K60.0-K60.2
ICD-9 565.0
DiseasesDB 673
MedlinePlus 001130
eMedicine med/3532  ped/2938 emerg/495

An anal fissure is an unnatural crack or tear in the anus skin. As a fissure, these tiny tears may show as bright red rectal bleeding and cause severe periodic pain after defecation.[1] The tear usually extends from the anal opening and located posteriorly in the midline. This location is probably because of the relatively unsupported nature of the anal wall in that location. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... // K00-K93 - Diseases of the digestive system (K00-K14) Diseases of oral cavity, salivary glands and jaws (K00) Disorders of tooth development and eruption (K01) Embedded and impacted teeth (K02) Dental caries (K03) Other diseases of hard tissues of teeth (K04) Diseases of pulp and periapical tissues (K040) Pulpitis (K05... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Female Human Anatomy Male Human Anatomy This article is about the bodily orifice. ...

Contents

Causes

Most anal fissures are caused by stretching of the anal mucosa beyond its capability. Various causes of this fissure include: The mucous membranes (or mucosa) are linings of ectodermic origin, covered in epithelium, that line various body cavities and internal organs. ...

Many acute anal fissures will heal spontaneously. Some fissures become chronic and will not heal. The most common cause for this is spasm of the internal anal sphincter muscle. This spasm causes poor blood flow to the anal mucosa, hence producing an ulcer which does not heal since it is deprived of normal blood supply. Rabbit feces are usually 0. ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause... Crohns disease (also known as regional enteritis) is a chronic, episodic, inflammatory condition of the gastrointestinal tract characterized by transmural inflammation (affecting the entire wall of the involved bowel) and skip lesions (areas of inflammation with areas of normal lining in between). ... Look up Sphincter in Wiktionary, the free dictionary. ...


Anal fissures are common in women after childbirth,[2] and following constipation in infants.[3] Childbirth (also called labour, birth, partus or parturition) is the culmination of a human pregnancy or gestation period with the delivery of one or more newborn infants from the mothers uterus. ...


Symptoms

The symptoms of anal fissure include:

  • Pain during, and even hours after, defecation
  • Visible tear in the anus
  • Blood on the stool or on toilet paper or toilet bowl
  • Constipation
  • Burning, possibly painful itching
  • A tearing sensation during defecation, sometimes described as "like passing glass".

This article or section does not cite its references or sources. ... Rabbit feces are usually 0. ... This article does not cite any references or sources. ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ...

Prevention

In infants under one year old, frequent diaper change can prevent anal fissure. For Adults, the following can help prevent fissure:

  • Treating constipation by eating food rich in dietary fiber, avoiding caffeine (which can cause dehydration), drinking a lot of water and taking stool softener.
  • Treating diarrhea promptly.
  • Lubricating the anal canal with KY Jelly or other water-based lube (petroleum jelly is not recommended because it can harbor harmful bacteria).
  • Avoiding straining or prolonged sitting on the toilet.
  • Using a moist wipe instead of perfumed and harsh toilet paper. Wipes NOT recommended.
  • Keeping the anus dry and hygienic.
  • When using Analpram (cream) do not use the dispenser which can injure the area. Instead use a finger to insert a pea size amount of cream.
  • Carmex lip ointment also helps and is much less expensive than Analpram ($70.00 small tube).

Fiber or fibre[1] is a class of materials that are continuous filaments or are in discrete elongated pieces, similar to lengths of thread. ... Caffeine is a xanthine alkaloid compound that acts as a stimulant in humans. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning through-flowing). Acute infectious diarrhea is a common cause...

Treatment

For many years up until 1995, customary treatment included warm baths, topical anesthetics, stool bulking agents, mechanical anal stretching, and, sometimes, surgery.[1] In 1995, doctors began using nitroglycerine cream (topical 1 percent isosorbide dinitrate) but found it less acceptable for long-term use due to patients developing a tolerance to the drug.[1] In 1998, Italian researchers reported injecting botulinum toxin into the anal sphincter to promote healing by relieving anal spasm through relaxiation of the muscle.[1] Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum. ...


Symptomatic

Most anal fissures are shallow or superficial (less than a quarter of inch or 0.64 cm deep). These fissures self-heal within a couple of weeks. Furthermore, treatment used for hemorrhoid such as eating a high-fiber diet, using stool softener, taking pain killer and having a sitz bath can help. This article or section is in need of attention from an expert on the subject. ... Hydrotherapy, formerly called hydropathy, is probably the oldest form of medical treatment. ...


Paediatric

Anal fissures in infants usually self-heal without anything more than frequently changing diapers and treating constipation if the cause.


Chemical sphincterotomy

Painful deep chronic fissures, on the other hand, will not heal because of poor blood supply caused by sphincter spasm. Traditionally surgical operations were required which are both painful and associated with various longterm complications, particularly incontinence in a small proportion of cases. Local application of medications to relax the sphincter muscle, thus allowing the healing to proceed, was first proposed in 1994 with nitroglycerine ointment,[4][5][6] in 1999 with nifedipine ointment,[7][8] and the following year with topical diltiazem.[9] Branded preparations are now available of topical nitroglycerine ointment (Rectogesic as 0.2% in Australia and 0.4% in UK) and diltiazem 2% (Anoheal in UK although still in Phase III development). Nitroglycerin (also nitroglycerine, trinitroglycerin, or glyceryl trinitrate) is a chemical compound, a heavy, colorless, poisonous, oily, explosive liquid obtained by nitrating glycerol. ... Nifedipine (brand name Adalat and Procardia) is a dihydropyridine calcium channel blocker. ... Diltiazem is a member of the group of drugs known as Benzothiapines , which are a class of calcium channel blockers, used in the treatment of hypertension, angina pectoris, and some types of arrhythmia. ...


Botulinum toxin injection, administered by colorectal surgeons, can also be used to relax the sphincter muscle and its use for this condition was first investigated in 1993.[10] Combination of medical therapies may offer up to 98% cure rates,[11] These medical treatments are used as first line therapy in treating chronic anal fissures,[12] although a Cochrane Collaboration review of published research has questioned the effectiveness of medical treatments compared to surgery.[13] Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum. ... The Cochrane Collaboration developed in response to Archie Cochranes call for systematic, up-to-date reviews (currently known as systematic reviews) of all relevant randomized clinical trials of health care. ...


Surgical sphincterotomy

Surgical intervention may be required for persisting deep anal fissures unresponsive to the above conservative measures. Procedures include:

  • Internal lateral sphincterotomy or excising a portion of the sphincter
  • Anal dilation or stretching of the anal canal is no longer recommended because of the unacceptably high incidence of fecal incontinence.[14] In addition, anal stretching can increase the rate of flatus incontinence.[15]

Despite the high success rate of these surgical procedures (~95%), there are potential side effects, which include: risks from anesthesia, infection and anal leakage (fecal incontinence). Excision means to remove as if by cutting. It can be a euphemism for Female circumcision. ... The tone or style of this article or section may not be appropriate for Wikipedia. ... Anesthesia or anaesthesia (see spelling differences) has traditionally meant the condition of having the perception of pain and other sensations blocked. ... An infection is the detrimental colonization of a host organism by a foreign species. ... The tone or style of this article or section may not be appropriate for Wikipedia. ...


In Popular Culture

  • In the episode, "Health Care", on the American version of the television show The Office, Dwight asks co-workers what their medical backgrounds are, including asking who has "anal fissures". We found out that Kevin suffers from the ailment.
  • In Smodcast #21, Popular Movie Maker Kevin Smith was found to have had an anal fissure.

References

  1. ^ a b c d Gott M.D., Peter H. (March 5, 1998) The Fresno Bee New thearpy coming for anal fissures. Section:Life; Page E2
  2. ^ Abramowitz L, Sobhani I, Benifla JL, et al (2002). "Anal fissure and thrombosed external hemorrhoids before and after delivery". Dis. Colon Rectum 45 (5): 650-5. PMID 12004215. 
  3. ^ Martínez-Costa C, Palao Ortuño MJ, Alfaro Ponce B, et al (2005). "[Functional constipation: prospective study and treatment response]" (in Spanish; Castilian). Anales de pediatría (Barcelona, Spain) 63 (5): 418-25. PMID 16266617. 
  4. ^ Loder P, Kamm M, Nicholls R, Phillips R (1994). "'Reversible chemical sphincterotomy' by local application of glyceryl trinitrate". Br J Surg 81 (9): 1386-9. PMID 7953427. 
  5. ^ Watson S, Kamm M, Nicholls R, Phillips R (1996). "Topical glyceryl trinitrate in the treatment of chronic anal fissure". Br J Surg 83 (6): 771-5. PMID 8696736. 
  6. ^ Simpson J, Lund J, Thompson R, Kapila L, Scholefield J (2003). "The use of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure in children.". Med Sci Monit 9 (10): PI123-6. PMID 14523338. 
  7. ^ Antropoli C, Perrotti P, Rubino M, Martino A, De Stefano G, Migliore G, Antropoli M, Piazza P (1999). "Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study". Dis Colon Rectum 42 (8): 1011-5. PMID 10458123. 
  8. ^ Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Chatzimavroudis G, Zavos C, Katsinelos T, Papaziogas B (2006). "Aggressive treatment of acute anal fissure with 0.5% nifedipine ointment prevents its evolution to chronicity". World J Gastroenterol 12 (38): 6203-6. PMID 17036396. 
  9. ^ Carapeti E, Kamm M, Phillips R (2000). "Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects". Dis. Colon Rectum 43 (10): 1359-62. PMID 11052511. 
  10. ^ Jost W, Schimrigk K (1993). "Use of botulinum toxin in anal fissure". Dis Colon Rectum 36 (10): 974. PMID 8404394. 
  11. ^ Tranqui P, Trottier D, Victor C, Freeman J (2006). "Nonsurgical treatment of chronic anal fissure: nitroglycerin and dilatation versus nifedipine and botulinum toxin" (PDF). Canadian journal of surgery. Journal canadien de chirurgie 49 (1): 41-5. PMID 16524142. 
  12. ^ Haq Z, Rahman M, Chowdhury R, Baten M, Khatun M (2005). "Chemical sphincterotomy--first line of treatment for chronic anal fissure". Mymensingh Med J 14 (1): 88-90. PMID 15695964. 
  13. ^ Nelson R (2006). "Non surgical therapy for anal fissure". Cochrane database of systematic reviews (Online) (4): CD003431. PMID 17054170. 
  14. ^ Kotlarewsky M, Freeman JB, Cameron W, Grimard LJ (2001). "Anal intraepithelial dysplasia and squamous carcinoma in immunosuppressed patients" (PDF). Canadian journal of surgery. Journal canadien de chirurgie 44 (6): 450-4. PMID 11764880. 
  15. ^ Sadovsky R (1 April 2003). "Diagnosis and management of patients with anal fissures - Tips from Other Journals" (Reprint). American Family Physician 67 (7): 1608. 

The Fresno Bee is the daily newspaper serving Fresno, California and surrounding counties in the states San Joaquin Valley. ...

External links


  Results from FactBites:
 
Hemorrhoid.net - Anal Fissure (1080 words)
An anal fissure (AY-nul FISH-er) is a tear in the anus causing a painful linear ulcer at the margin of the anus.
Because of an associated anal crypt infection, causing cryptitis, a fissure, an ulcer, or possibly even an abscess may occur at the superior aspect of the anal canal where it attaches to the lower rectal mucosa.
Since anal fissures are characterized by spasm of the internal anal sphincter and a reduction in mucosal blood flow, the aim of treatment is to relieve ischemia by reducing resting anal pressure and improving mucosal perfusion.
MedlinePlus Medical Encyclopedia: Anal fissure (528 words)
An anal fissure is a small split or tear in the anal mucosa that may cause painful bowel movements and bleeding.
In adults, fissures may be caused by constipation, the passing of large, hard stools, or by prolonged diarrhea.
Anal fissures are also common in women after childbirth and people with Crohn's disease.
  More results at FactBites »

 
 

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