ABSTRACT
This chapter discusses the causes of anal fissure. Fissures are also commonly seen in inflammatory bowel disease and sexually transmitted diseases. The chapter presents the symptoms of a fissure: exquisite pain on defecation, bleeding, itching, and constipation. Conservative treatment and surgical treatment are treatments available for anal fissures. A complication of perianal abscesses is the subsequent formation of a fistula, which occurs in 30–50% of drained abscesses. The bacteria isolated from the pus are an important predictor of fistula formation. Fistulas may be classified according to the Park’s Classification as follows: intersphincteric, trans-sphincteric, extrasphincteric, and suprasphincteric. It is important to identify the tract of the fistula. Those that run below the puborectalis are classified as low fistulas. Management of these has a lower risk of incontinence due to damage of the sphincter mechanism. The chapter describes the commonest cause of a perianal abscess.
