296 STEINHAGEN: ANAL FISSURE RESIDENT'S CORNER Kim Champion Lu, M.D. Portland, Oregon r Steinhagen has succinctly reviewed the diag- appreciated by patients, especially if applied just before nosis and management of anal fissures, one of a bowel movement. Dr Steinhagen’s algorithm allows for Dthe most common reasons for a person to visit a either topical calcium channel blockers or nitrates as the colorectal surgeon. Although isolated anal pain or bleed- topical medical therapy. Off-label use of diltiazem com- ing with defecation might be ignored by many patients, pounded to a 2% ointment or gel has lower cost and fewer with both pain and bleeding, many patients seek medi- headaches than topical nitroglycerin. Instructing the pa- cal evaluation. For some, the severity of this pain can ri- tient to use a glove or even plastic wrap over the finger will val that of childbirth and ureterolithiasis, whereas others limit absorption through the finger. For refractory fissures, Dr Steinhagen’s algorithm in- have milder symptoms and want to be reassured that they do not have cancer. cludes lateral internal sphincterotomy (LIS) or off-label History is key to the diagnosis. The most common use of botulinum toxin (Botox) without preference. I find that
Diseases of the Colon & Rectum – Wolters Kluwer Health
Published: Mar 1, 2018
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