B. History and superficial clinical examination
C. PR examination
Ans:B. History and superficial clinical examination.
The patient in question is suffering from Anal Fissure.
- An anal fissure is a painful linear tear or crack in the distal anal canal, which, in the short term, usually involves only the epithelium and, in the long term, involves the full thickness of the anal mucosa.
- The exact etiology of anal fissures is unknown, but the initiating factor is thought to be trauma from the passage of a particularly hard or painful bowel movement.
- Low-fiber diets (eg, those lacking in raw fruits and vegetables) are associated with the development of anal fissures.
- Prior anal surgery is a predisposing factor because scarring from the surgery may cause either stenosis or tethering of the anal canal, which makes it more susceptible to trauma from hard stool.
- The most commonly observed abnormalities are hypertonicity and hypertrophy of the internal anal sphincter, leading to elevated anal canal and sphincter resting pressures.
- This condition is best diagnosed by History and superficial clinical examination
- Medical Therapy
- Initial therapy for an anal fissure is medical in nature, and more than 80% of acute anal fissures resolve without further therapy. The goals of treatment are to relieve the constipation and to break the cycle of hard bowel movement, associated pain, and worsening constipation.
- First-line medical therapy consists of therapy with stool-bulking agents, such as fiber supplementation and stool softeners. Laxatives are used as needed to maintain regular bowel movements.
- Second-line medical therapy consists of intra-anal application of 0.4% nitroglycerin (NTG; also called glycerol trinitrate) ointment directly to the internal sphincter.
- Botulinum toxin has been used to treat acute and chronic anal fissures. It is injected directly into the internal anal sphincter, in effect performing a chemical sphincterotomy.
- The effect lasts about 3 months, until nerve endings regenerate.
- Surgical therapy :
- Sphincter dilatation,Lateral internal sphincterotomy,
- It is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures.
- The main contraindication to surgery for an anal fissure is impaired fecal continence