The following symptoms and complaints may indicate anal fissure (anal fissure): Leading symptoms Defecation-dependent anal pain: pain in the anal area/anorectal pain (severe, stabbing), especially during defecation. Anal spasm Pruritus (itching) at the anus Bright bloody stool deposits (or bright red blood on the toilet paper). Note: if necessary, presence of higher-grade hemorrhoidal disease with … Anal Fissure: Symptoms, Complaints, Signs
Pathogenesis (development of disease) In the pathogenesis of primary anal fissures, hypertonicity of the sphincter muscle plays a central role. Consequently, all causes that increase sphincter tone (sphincter muscle tone) should be discussed. Classically, this is mainly constipation and hard stool. A secondary anal fissure is caused by an injury of the anal canal due … Anal Fissure: Causes
General measures Root Cause Remediation: Stool regulation Sitz baths (increase patient comfort but are not thought to affect healing rates). Aim for normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program. Conventional non-surgical … Anal Fissure: Therapy
2nd order laboratory parameters – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification. Serological and microbiological tests (HIV, CMV, Chlamydia trachomatis, lymphogranuloma venerum, Neissereia gonorrhoea, histoplasmosis, leishmaniasis). Biopsy (tissue sampling) – if Crohn’s disease is suspected.
Therapy goals Improvement of symptomatology, i.e., elimination of pain and reduction of sphincter pressure. Healing of anal fissure Therapy recommendations Acute anal fissure Antiseptic (agents that destroy bacterial, viral, and other microbial agents of infectious diseases) + local anesthetic (agent for local anesthesia) for external (“external”) therapy) → reduction of resting pressure in the sphincter … Anal Fissure: Drug Therapy
Medical device diagnostics are usually not required. Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification. Proctoscopy (rectoscopy; examination of the anal canal and lower rectum/rectum; under local/local anesthesia; also under anesthesia if necessary); indications: In case of … Anal Fissure: Diagnostic Tests
If there is still no healing after 6-8 weeks of conservative therapy (= chronic anal fissure) and the symptoms last, surgical therapy should be performed. 1st order Fissurectomy (according to Gabriel): excision (cutting out) of the fissure/scar in chronic anal fissure; the resulting wound area is left to free granulation (formation of young connective tissue … Anal Fissure: Surgical Therapy
To prevent anal fissure (anal fissure), attention must be paid to reducing individual risk factors. Behavioral causes Sexual habits (anal intercourse/anal sex).
Medical history (history of illness) represents an important component in the diagnosis of anal fissure (anal fissure). Family history Social history Current anamnesis/systemic anamnesis (somatic and psychological complaints). How long have the complaints existed? Does the pain occur continuously or in episodes? Where exactly is the pain located? Have you noticed any other symptoms: Bright … Anal Fissure: Medical History
Infectious and parasitic diseases (A00-B99). Tuberculosis (consumption). Venereal infections – infectious diseases such as syphilis that are transmitted through sexual intercourse. Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93). Anal abscess – encapsulated collection of pus located in the anal canal. Anal fistula – abnormal duct connection originating in the anal canal → clarification … Anal Fissure: Or something else? Differential Diagnosis
The following are the most important diseases or complications that can be caused by anal fissure (anal tear): Mouth, esophagus (food pipe), stomach, and intestines (K00-K67; K90-K93). Peranal hemorrhage (bleeding from the anus). Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99) Chronic pain-related constipation (constipation). Chronic pain in the anal region
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin and mucous membranes Abdomen Shape of the abdomen? Skin color? Skin texture? Efflorescences (skin changes)? Pulsations? Bowel movements? Visible vessels? Scars? Hernias (fractures)? Anal region / anal canal … Anal Fissure: Examination
