Fissure-in-ano
- Tear at the anal margin due to passage of constipated stool
- Usually in midline posterior (Occasionally anterior)
- Multiple may be due to Crohn's
disease
Symptoms and Signs
- Acute anal pain, severe on defaecation
- Acute sphincter spasm, PR impossible
- Occasional sentinel pile
Differential Diagnoses
Treatment
- LA gel or suppository half an hour before defaecation
- Stool softening
- Sphincter stretch (Lord's)
- Lateral subcutaneous sphincterotomy
- Excision of fissure if recurrent
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