This area has somatic sensation and is the reason why anal fissures are painful. The epithelium of the anal canal between the anal verge below and the pectinate line above is anal mucosa. The anatomical anal canal is approximately 2 cm in length and extends from the anal verge distally to the dentate line (junction of the ectoderm and endoderm in the anal canal) proximally. The surgical anal canal is approximately 4 cm long extending from the anal verge (anocutaneous line) to the anorectal ring (muscular ring formed at the junction of the rectum and anal canal) proximally. The anal canal can be described in terms of the ‘surgical’ and ‘anatomical’ anal canal.
#SENTINEL PILE DEFINITION SKIN#
It is frequently associated with a hypertrophic anal papilla at its proximal aspect and with an irritated skin tag or sentinel pile at its distal aspect. A chronic fissure is usually deeper and generally has exposed internal anal sphincter (IAS) fibres at its base. Risk factors included chronic constipation, obesity, hypothyroidism, and solid tumours.Īn acute anal fissure has the appearance of a clean longitudinal tear in the anoderm, sometimes with surrounding inflammation. One retrospective population-based study found that anal fissures most commonly affected females aged 12–24 years and males 55–64 years of age. There are approximately 342,000 new cases diagnosed in the United States of America annually, a figure similar to appendectomies performed, but study estimates vary widely. person-years is reported, equivalent to an average lifetime risk of 7.8%. As patients may be embarrassed about the anatomic location of their symptoms, they may present to care late in the course of their illness.Īn annual incidence of 1. This feature helps to distinguish anal fissure from other causes of anal pain such as perianal and ischiorectal abscesses, thrombosed haemorrhoids, viral ulcers, and others. It usually causes pain both during and for 1–2 h after defecation. Patients often describe the pain they experience during a bowel movement as ‘passing shards of glass’, and the pain is often associated with rectal bleeding.Īn anal fissure is an ulcer like longitudinal tear in the squamous epithelium of the anal canal, which extends from the anal verge cephalad sometimes up to the level of the dentate line. Anal fissure, also known as fissure-in-ano, is a common cause of perianal pain.
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