Anal fissure: The Daily PANCE Blueprint

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Anal fissure: The Daily PANCE Blueprint

A 65-year-old female with a history of chronic constipation presents to your clinic due to severe pain while having bowel movements. She states that one day last week she had an episode of tearing pain and bleeding while defecating. Ever since it has been painful to use the bathroom. On physical exam, you notice a small crack in the perianal region. What is the best management for this patient at this time?

A. Local pain infection only
B. Topical analgesics and incision/drainage
C. Fiber and sitz baths
D. Oral vasodilators
E. Referral to colorectal surgery

Answer and topic summary

The answer is C. Fiber and sitz baths

An anal fissure is a tear of the perianal skin (distal to the dentate line). Etiologies include trauma (e.g., chronic constipation, vaginal delivery, anal sex) or due to something else (previous anal surgery, IBD, infections, cancer, or TB). Most of the time anal fissures are located at the POSTERIOR commissure. Clinical features include sharp/severe pain during defecation. Initial treatment is conservative (dietary changes, stool softeners, sitz baths, anti-inflammatory creams, local pain injection, topical vasodilators, etc). Definitive treatment (surgery) is indicated when conservative measures fail. Surgery is a LAST resort.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Colorectal disorders ⇒ Anal fissure

Also covered as part of the Family Medicine EOR, Internal Medicine EOR, and Emergency Medicine EOR topic lists

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