For 2nd year B.Sc Nursing students

1. ANAL FISSURE
Presented By:
Mr. Nandish. S
Asso. Professor
Mandya Institute of Nursing Sciences

2. Definition :
o It is a skin ulcer or a crack in the lining of anal wall.
o It is a longitudinal tear or ulceration in the anal canal distal to
the dentate line.

4. Etiology :
Based on the causes, it is classified into primary & secondary fissure.
Primary : it occurs as a result of local trauma associated with
defecation. Ex : high pressure in the internal anal sphincter,
constipation.
Secondary : it is due to variety of infections. Inflammatory Bowel
Disease (ulcerative colitis), prior anal surgery, infections (Syphilis,
Gonorrhea, HSV, HIV)
Other causes : childbirth, Trauma.

5. Clinical Manifestations :
• Painful defecation (spasm of anal sphincter)
• Burning sensation
• Bleeding (bright red blood)
• Constipation (because of fear of pain)
Diagnostic studies :
• History collection
• Physical examination

6. Conservative Treatment :
- It require 2 to 4 weeks to heal.
- Warm Sitz bath 3 times a day (for 15 to 20 minutes)
- Dietary modification with fiber rich diet, stool softners & more
water intake.
- Application of Nitroglycerin topical ointment before &
immediately after defecation.
- Injection of Botulinum which results in reversible paralysis of
internal anal sphincter.

7. Surgical management :
- Coagulation therapy
- Sphincterotomy
- Excision of Fissure

8. Thank you