Anal Fissures

Clinical Description

Painful small cracks just inside the anal margin, sometimes may be present with a linear ulcer. It is often seen with a sentinel pile or external haemorrhoids.

Signs and Symptoms

• May cause spasm of the anal sphincter, and maybe associated with bleeding on defaecation.

Non-pharmacological

• Dietary advice to promote soft stools

Pharmacological

Children

• Lactulose oral 0.5ml/kg/dose daily
• If no response increase frequency to twice daily.

Adults

• lactulose, oral, 10-20ml once daily
• If poor response increase frequency to twice daily
• Bismuth subgallate compound, ointment, topical, applied 2-4 times daily

Or

• Lidocaine 2% cream applied before and after each bowel action.

Complications and Referral Criteria

• severe pain
• recurrent episodes
• Poor response to symptomatic treatment
• Persistent anal bleeding 7.9.2. HAEMORRHOIDS

Clinical Description

• Varicose veins of the anorectal area. Usually accompanied by a history of constipation. In older patients consider a diagnosis of an underlying carcinoma.

Treatment

• High fiber diet
• Counsel against chronic use of laxatives
• Avoid straining with defecation

Pharmacological

• (Hydrocortisone acetate, Allantoin, Zinc oxide, Lidocaine) combination suppositories once daily for 2 weeks
• If no response increase frequency to 2-3 for 2 weeks

Complications and Referral Criteria

• Haemorrhoids cannot be reduced
• Thrombosed
• poor response to symptomatic treatment

Children

• If Persistent bleeding