Rectal and anal disorders

Question 1

An anal fissure is a

Answer 1

• tear or ulcer in the lining of the anal canal. Symptoms include bleeding and pain on defecation.
• Bulk-forming laxatives can be used to ensure stools are soft and easily passed. An alternative is Osmotic laxatives e.g. Lactulose.
• For the pain relief, lidocaine (anaesthetic) or an analgesic (paracetamol/ibuprofen) may be considered.

Question 2

Haemorrhoids are

Answer 2

• abnormal swellings around the anus. Women are more likely to develop haemorrhoids during pregnancy.
   Stools should be kept soft and easy to pass (to minimise straining) by dietary fibre and fluid intake.
   If constipation is reported it should be treated using a Bulk-forming laxative. A simple analgesic e.g. Paracetamol can be used for pain relief. Avoid Opioid analgesics due to constipation and NSAIDs if rectal bleeding.
   Topical Preparations generally contain a local anaesthetic and corticosteroid e.g. Anusol HC.
  Bulk-forming laxatives can be used in pregnancy, but Topical preparations cannot be used in pregnancy

Question 3

Chronic anal fissure treatment

Answer 3

> 6 weeks - glyceryl trinate rectal ointment (SE headache)