A 28-year-old lady is seen in clinic regarding pain on defaecation. You diagnose an anal fissure.

Give two symptoms she may describe in her history. (2 marks)

What position in the anus are anal fissures most likely to occur? (1 mark)

Name a situation where one may form in the anterior wall. (1 mark)

Anal fissures are usually shallow and heal without intervention. Deeper ones are more problematic and do not heal as easily. Explain the pathology which leads to this. (2 marks)

Anal fissures can be managed medically or surgically depending on their severity. Name two medical treatments. (2 marks)

Anal dilation has previously been used as a surgical management option. Explain why this is no longer performed. (1 mark)

What is the current choice of surgical intervention for anal fissures? (1 mark)