Anal Fissure, Emergency Medicine

Julia H. Sone Reviewed 06/2017
 


Basics

Description

  • Hard stool passes and “cuts” anoderm

  • Linear tear extends from dentate line to anoderm:

    • Posterior midline 95%

    • Anterior midline 5%

    • Externally: Forms skin tag or sentinel pile

    • Internally: Fo...

Diagnosis

Signs and Symptoms

  • Bright red blood per rectum usually on toilet paper

  • Sharp, cutting, throbbing or burning pain with bowel movement:

    • May last for hours

  • Constipation; unable to pass stool owing ...

Treatment

Pre-Hospital

Establish IV access for patients with significant rectal bleeding. 

Initial Stabilization/Therapy

Administer pain medications for patients with significant pain. 

Ed Treatment/Procedures

Follow-Up

Disposition

Admission Criteria

Severe abdominal pain/distention due to fecal impaction 

Discharge Criteria

  • Initial treatment is conservative therapy for acute anal fissures as an outpatient.

  • Oper...

Pearls and Pitfalls

  • Perform a careful physical exam of rectal area to delineate fissures and exclude other pathology.

  • Provide combination of pain relief and muscle relaxants for patients with significa...

Additional Reading

  • Herzig  DO, Lu  KC. Anal Fissure. Surg Clinf North Am.  2010;90(1):22–44.

  • Nelson  RL, Thomas  K, Morgan  J, et al. Non-surgical Therapy for Anal Fissure. Cochrane Database Syst ...

Codes

ICD9

565.0 Anal fissure 

ICD10

  • K60.0 Acute anal fissure

  • K60.1 Chronic anal fissure

  • K60.2 Anal fissure, unspecified

SNOMED

  • 30037006 Anal fissure (disorder)

  • 197152000 Chronic anal fissure (disorder)

  • 197151...

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