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Fissure Fistula Hemorrhoids History Examination Investigation Treatment

The document compares Fissure in Ano, Fistula in Ano, and Hemorrhoids, detailing their main complaints, pain characteristics, bleeding patterns, discharge, and associated symptoms. It outlines examination findings, including inspection and palpation results, as well as recommended investigations and treatment options for each condition. The treatment approaches vary from conservative methods like dietary changes and topical agents to surgical interventions depending on the severity and type of condition.

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1 views2 pages

Fissure Fistula Hemorrhoids History Examination Investigation Treatment

The document compares Fissure in Ano, Fistula in Ano, and Hemorrhoids, detailing their main complaints, pain characteristics, bleeding patterns, discharge, and associated symptoms. It outlines examination findings, including inspection and palpation results, as well as recommended investigations and treatment options for each condition. The treatment approaches vary from conservative methods like dietary changes and topical agents to surgical interventions depending on the severity and type of condition.

Uploaded by

Yosra —
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Fissure in Ano, Fistula in Ano, and Hemorrhoids – History, Examination,

Investigation, and Treatment


Feature Fissure in Ano Fistula in Ano Hemorrhoids

Main complaint Severe pain during Persistent or Painless bleeding


and after defecation intermittent during defecation
discharge (pus or
mucus) from
opening near anus

Pain Severe, sharp, Dull aching pain, Usually painless


tearing pain during worse before (pain only if
defecation that may discharge and thrombosed)
persist for hours relieved after it

Bleeding Bright red blood Minimal or absent Bright red blood


streaking the stool that drips after
or on tissue (not defecation or stains
mixed with stool) the toilet

Discharge Rare (unless Pus or mucus None (unless


infected fissure) discharge from infected or
external opening prolapsed
hemorrhoid
ulcerates)

Relation to Pain and bleeding Discharge Bleeding after


defecation with defecation independent of defecation, no pain
defecation

Associated Constipation and History of perianal Mucosal prolapse,


symptoms fear of defecation abscess, fever (if itching, mucus
active infection) discharge (if
internal
hemorrhoids
prolapse)

Systemic symptoms Usually none Fever and malaise if None


abscess present
Inspection Linear tear in External opening Prolapsed
posterior midline, with discharge, hemorrhoids or
sentinel tag if induration, fibrosis congested veins on
chronic straining

Palpation Very painful, DRE Palpable induration Soft swellings, may


often not tolerated or cord-like tract prolapse with
straining

Digital Rectal Exam Avoid in acute May reveal internal Internal


(DRE) fissure due to pain opening or tract hemorrhoids felt as
soft bulges

Investigations Mainly clinical Proctoscopy, Proctoscopy/


diagnosis. If chronic fistulography, MRI anoscopy to assess
or atypical, rule out pelvis (to define grade, CBC if
Crohn’s, TB, tract), EUA bleeding.
carcinoma. (examination under
anesthesia).

Treatment ✅ Conservative: ✅ Surgical: ✅ Conservative:


High-fiber diet, stool Fistulotomy Fiber, avoid
softeners, sitz baths, (simple), Seton straining, topical
topical placement (high agents.
GTN/diltiazem, fistula), ✅ Non-surgical:
topical anesthetic. advancement flap Rubber band
✅ Surgical: Lateral (complex cases). ligation,
internal ✅ Antibiotics for sclerotherapy,
sphincterotomy for abscess. infrared
chronic fissure. coagulation.
✅ Surgical:
Hemorrhoidectomy
for grade III–IV.

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