Anal Fistulas and Fissures Questions & Answers

Updated: Nov 09, 2018
  • Author: Bruce M Lo, MD, MBA, CPE, RDMS, FACEP, FAAEM, FACHE; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Questions & Answers

Overview

What is an anal fissure?

What are anal fistulas and how are they categorized?

What causes anal fissures?

What is the role blood flow in the pathogenesis of anal fissures?

What is the pathophysiology of anal fistulas?

What are the types of anal fistulas?

What is the epidemiology of anal fissures?

What is the prevalence of anal fistulas due to anorectal abscess?

What is the prognosis of anal fissures?

What is the prognosis of anal fistulas?

Presentation

Which history is characteristic of anal fissure?

What are symptoms of an anal fistula?

How is the physical exam for anal fistula or fissure performed?

What are the physical findings indicative of chronic fissures?

Which bidigital rectal exam findings indicate anal fistula?

What are complications of anal fissure?

What are complications of surgical intervention for an anal fissure?

What is a possible complication of chronic untreated anal fistulas?

DDX

What are the differential diagnoses for Anal Fistulas and Fissures?

Workup

How are anal fissures diagnosed?

How are anal fistulas diagnosed?

Treatment

What are the treatment options for anal fissures?

What is the WASH treatment for anal fissures?

Which medications are used to treat anal fissures?

What is the role of botulinum toxin in the treatment of anal fissures?

Which treatments for anal fissures are being investigated?

What is the role of surgery in the treatment of anal fissures?

What are the treatment options for anal fistulas?

What is the role of antibiotics in the treatment of anal fistulas?

What is the role of local injections in the treatment of anal fistulas associated with Crohn's disease?

What are guidelines for treating anal fistulas associated with Crohn's disease?

What is the role of calcium channel blockers in the treatment of anal fissures?

What is the role of topical nitrates in the treatment of anal fissures?

What is the dosing for topical nitrates to treat anal fissures?

What is the efficacy of botulinum toxin A (Dysport for the treatment of chronic anal fissures?

What is the role of OnabotulinumtoxinA in the treatment of anal fissures?

What is the role of topical analgesics in the treatment of anal fissures?

What is the role of surgery in the treatment of anal fissures?

What is the surgery of choice for chronic anal fissures?

What are alternative techniques for surgical treatment of chronic anal fissures?

What are the surgical options for simple anal fistulas?

What are the surgical options for complex anal fistulas?

What is the role of ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistulas?

What is the efficacy of surgery of anal fistulas?

What is the efficacy of ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistulas?

What is video-assisted anal fistula treatment (VAAFT)?

Medications

Which medications are used in the treatment of anal fissures and anal fistulas?

Which medications in the drug class Neuromuscular Blockers, Botulinum Toxins are used in the treatment of Anal Fistulas and Fissures?

Which medications in the drug class Calcium Channel Blockers are used in the treatment of Anal Fistulas and Fissures?

Which medications in the drug class Antibiotics are used in the treatment of Anal Fistulas and Fissures?

Which medications in the drug class Anxiolytics, Benzodiazepines are used in the treatment of Anal Fistulas and Fissures?

Which medications in the drug class Vasodilators are used in the treatment of Anal Fistulas and Fissures?

Which medications in the drug class Laxatives, Bulk-Producing are used in the treatment of Anal Fistulas and Fissures?