Anal Fissure

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of anal pain

Rated at ‍012345678910 / 10 ‍

Described as ‍sharpstabbing

Pattern ‍persistentintermittent

Worsening factors: ‍nonebowel movement

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍rectal bleeding, ‍oncetwice ‍, ‍bright reddark red, ‍withwithout clots

‍lump

‍redness

‍discharge

‍itching

‍swelling

‍difficulty passing stools

‍constipation

‍diarrhea, ‍ episodes ‍per day, ‍

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills



Contributing factors:

‍constipation

‍straining with bowel movements

‍diarrhea, ‍ episodes ‍per day, ‍

‍anal sex

‍use of irritants such as soaps

‍poor hygiene

‍obesity

‍pregnancy

no history of: ‍anal fissure, ‍hemorrhoids, ‍anal abscess, ‍inflammatory bowel disease

no use of: ‍laxatives, ‍stool softeners, ‍opioids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Anal fissure ‍likelysuspectedpossible

DDx: anal fissure, hemorrhoids, colorectal cancer, sexually transmitted infections, chronic diarrhea, constipation, trauma, anal intercourse, perianal abscess, fistula-in-ano, Crohn's disease, ulcerative colitis, anal cancer





PLAN:

Investigations:

- Colonoscopy

Treatments:

- ‍Analgesics

- ‍Topical treatments

- ‍Stool softeners

- Sitz baths

- Increase fluid intake

- Increase dietary fiber

Further care:

- Referral to gastroenterologist

- Referral to surgeon

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen, if new symptoms develop such as weight loss or blood in stools, or if symptoms do not improve with treatment