Aimee Lettis gives us short, sharp nuggets of clinical information for sessional GPs.
I’ll cover something you will be familiar with as GPs: anal fissures, as well the new test on the block, faecal calprotectin.
Anal fissures
Maybe not the most glamorous of conditions, but a common (1 in 10 lifetime risk) and painful one! Here, I outline a recent DTB review on the non-surgical management (DTB 2013;51(9):102). But first, a quick refresher:
Aetiology
- Acute fissures may be caused by passing a hard stool or postpartum, and most heal spontaneously
- Chronic fissures last for > 6w and usually need treatment.
- Occasionally fissures indicate an underlying illness such as Crohns, HIV, TB or syphilis.
Presentation
- Main symptoms are sharp pain and bleeding on defecation, possibly with burning pain afterwards.
- Examination should reveal a midline fissure, usually posteriorly.
