ANAL FISSURE
Anal Fissure is a longitudinal ulcer in the anal canal.
Causes
1. Constipated stools may tear anal living.
2. Perineum strain during childbirth.
3. Tuberculosis, syphilis, Crohn's disease may be a cause
4. Others-Trauma and cathartic abuse.
Clinical Manifestations
Tearing acute pain during and after bowel movement, spotting of bright red blood with stool, spasm of anal canal; Burning/discomfort may continue for several hours after bowel movement.
Sudden involuntary Muscle Contraction.
Medical Management
1. Stool softeners and an increase in water intake; a bland laxative will prevent constipation.
2. A suppository combining an anesthetic with a steroid provides comfort. Analgesics, sitz baths and bulk producing agents e.g. psyllium - provided.
3. Surgery-The anal sphincter is dilated and fissure is excised (fissurectomy). The external sphincter is divided establishes a paralysis of the external sphincter, with consequent relief of spasm and permits the ulcer to heal
Nursing Management
1. Assist with warm sitz baths and local application of anesthetic ointment to reduce pain.
2. Instruct to eat high-fibre foods and drink fluids to prevent constipation.
3. Administer analgesics, stool softeners and bulk forming laxatives as ordered.
Complications
Rare complications include abscess, fistula, septicaemia and haemorrhage Chronic fissure may produce scar tissue that hampers normal bowel evacuation.
