(2) Removal of thrombosed eternal hemorrhoid. A vein ruptures at the anal
margin and forms a blood clot in the subcutaneous tissue. This condition is a
thrombosed external hemorrhoid. The patient feels a painful lump. Examination
reveals a tense, tender, bluish mass covered with skin. If the hemorrhoid is less than
seventy-two hours old, it can be removed locally by following this procedure. Wash the
area with antiseptic. Apply one percent lidocaine around and over the lump. Make a
radial ellipse skin incision and remove the clot.
Surgery. Complicated or extensive cases may require surgery.
3-16. ANAL FISSURE
a. Definition. An anal fissure is a linear ulcer on the border of the anus. Such
an ulcer involves the skin of anal wall.
b. Etiology. This condition is caused by straining to have bowel movements.
c. Signs and Symptoms. Chronic anal fissure is characterized by chronic
acute pain during and after bowel movements. Afraid of pain, the person may become
constipated. The condition tends to occur over and over with the fissure healing and
then developing again. Constipation reactivates the condition.
d. Diagnosis. Anal fissures are frequently misdiagnosed as hemorrhoids. A
skin tag protruding from the anal border (a sentinal pile tag) is an indication of anal
fissure. Pull the buttocks apart and partially turn the anal canal outward. Examine by
inspection for anal fissure. Gently palpate the area; an anal fissure will be tender.
e. Treatment. Treatment includes conservative measures such as the
Establish a schedule of regular bowel movements.
Give stool softeners and bland laxatives; for example, mineral oil.
Have the patient take Sitz baths.
Administer suppositories with steroids such as Anusol.
May require stretching of the anal muscle.
(6) If these measures fail, surgical division of the internal anal muscle may