RESIDENT’S CORNER Emily Steinhagen, M.D. Division of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio CASE SUMMARY: A 30-year-old otherwise healthy decreases blood flow to the area and prevents healing once a woman presents with 1 week of pain, “like passing fissure has formed. The association between fissures and hy- glass,” with defecation and bright red blood with bowel pertonic sphincters has been demonstrated manometrically, movements. She typically has hard stools. as has the association between hypertonic sphincter and de- creased blood flow to the anoderm. CLINICAL QUESTIONS PRESENTATION The most frequent symptom for fissure patients is sharp • What are the presenting signs and symptoms of anal pain. Patients may describe having a bowel movement like fissure? passing glass or razor blades. The pain is worst with, and • What are the medical and surgical treatment immediately after, bowel movements. In more chronic options? cases, constant pain may be reported as muscular hyper- trophy occurs and sphincter spasm begins to contribute to the pain process. Patients often report bright red blood BACKGROUND either streaking the stool or when wiping. On physical examination, patients with an acute fis- Anal fissures are longitudinal tears in the anal canal, distal sure
Diseases of the Colon & Rectum – Wolters Kluwer Health
Published: Mar 1, 2018
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