D95 Anal fissure/perianal abscess (ICD-10:K60, K61)

Introduction

Anal fissure and perianal abscess are common conditions that affect the anal area. Anal fissures are small tears in the lining of the anus^[1], while perianal abscesses are pus-filled infections near the anus^[2]. These conditions can cause significant discomfort and pain, and it is important to diagnose and treat them promptly^[3]. This guide aims to provide healthcare professionals with a comprehensive approach to diagnosing and managing anal fissures and perianal abscesses.

Codes

• ICPC-2 Code: D95 Anal fissure/perianal abscess
• ICD-10 Code: K60 Fissure and fistula of anal and rectal regions, K61 Abscess of anal and rectal regions

Symptoms

• Pain during bowel movements^[4]
• Bright red blood on the stool or toilet paper^[5]
• Itching or irritation around the anus^[6]
• Swelling or a lump near the anus^[7]
• Pus or discharge from the anus^[8]

Causes

• Constipation or straining during  bowel movements^[9]
• Diarrhea or loose stools^[10]
• Inflammatory bowel disease
• Crohn’s disease
• Sexually transmitted infections
• Weakened immune system

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the duration and severity of pain, presence of blood in the stool, and any associated symptoms.
• Ask about the patient’s bowel habits, including frequency, consistency, and any changes.
• Inquire about any previous episodes of anal fissures or perianal abscesses.
• Assess the patient’s medical history, including any underlying conditions or medications that may contribute to the development of anal fissures or perianal abscesses.
• Determine if the patient has any risk factors for sexually transmitted infections.

Physical Examination

• Perform a visual inspection of the anus and perianal area to look for signs of fissures, abscesses, or inflammation.
• Palpate the area to assess for tenderness, swelling, or the presence of a lump.
• Perform a digital rectal examination to evaluate the rectal tone and assess for any abnormalities or masses.
• Check for any signs of infection, such as redness, warmth, or drainage.

Laboratory Tests

• Stool culture: To rule out any infectious causes of diarrhea or inflammation.
• Complete blood count (CBC): To assess for signs of infection or inflammation.
• Sexually transmitted infection (STI) testing: If there is a suspicion of an STI as the underlying cause.

Diagnostic Imaging

• Anorectal ultrasound: To evaluate the extent and depth of the fissure or abscess.
• Magnetic resonance imaging (MRI): To assess the extent of the abscess and identify any associated fistulas or other complications.

Other Tests

• Colonoscopy: If there is a suspicion of underlying inflammatory bowel disease or other colorectal conditions.
• Biopsy: If there are any suspicious lesions or masses that require further evaluation.

Follow-up and Patient Education

• Schedule a follow-up appointment to monitor the patient’s progress and response to treatment.
• Provide education on proper anal hygiene, including gentle cleansing and avoiding excessive wiping.
• Advise the patient on dietary modifications to promote regular bowel movements and prevent constipation.
• Discuss the importance of maintaining good hydration and incorporating fiber-rich foods into the diet.
• Educate the patient on the signs and symptoms of recurrence or complications and when to seek medical attention.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Anal fissure/perianal abscess:

1. Topical analgesics (e.g., Lidocaine ointment):
   • Cost: $10-$30 per tube.
   • Contraindications: Hypersensitivity to local anesthetics.
   • Side effects: Local skin irritation or allergic reactions.
   • Severe side effects: Rare, but may include systemic allergic reactions.
   • Drug interactions: None reported.
   • Warning: Use with caution in patients with liver or kidney disease.
2. Topical nitroglycerin:
   • Cost: $30-$60 per tube.
   • Contraindications: Hypersensitivity to nitrates, recent use of phosphodiesterase inhibitors.
   • Side effects: Headache, dizziness, flushing.
   • Severe side effects: Hypotension, methemoglobinemia.
   • Drug interactions: Phosphodiesterase inhibitors (e.g., sildenafil).
   • Warning: Use with caution in patients with low blood pressure or history of heart disease.
3. Topical calcium channel blockers (e.g., Diltiazem ointment):
   • Cost: $30-$60 per tube.
   • Contraindications: Hypersensitivity to calcium channel blockers.
   • Side effects: Local skin irritation or allergic reactions.
   • Severe side effects: Rare, but may include systemic allergic reactions.
   • Drug interactions: None reported.
   • Warning: Use with caution in patients with heart conditions or low blood pressure.
4. Stool softeners (e.g., Docusate sodium):
   • Cost: $5-$15 per bottle.
   • Contraindications: Hypersensitivity to stool softeners.
   • Side effects: Diarrhea, abdominal cramping.
   • Severe side effects: None reported.
   • Drug interactions: None reported.
   • Warning: Use as directed and avoid long-term use without medical supervision.
5. Antibiotics (e.g., Metronidazole, Ciprofloxacin):
   • Cost: Varies depending on the specific antibiotic and formulation.
   • Contraindications: Hypersensitivity to antibiotics, history of tendon disorders (for fluoroquinolones).
   • Side effects: Nausea, diarrhea, abdominal pain.
   • Severe side effects: Rare, but may include severe allergic reactions or tendon rupture (for fluoroquinolones).
   • Drug interactions: Many potential drug interactions, consult a drug information database for specific details.
   • Warning: Use antibiotics judiciously and follow appropriate guidelines for duration and dosage.

Alternative Drugs:

• Botulinum toxin injections: May be considered for chronic anal fissures that do not respond to traditional treatments. Cost: $500-$1000 per injection.
• Sitz baths: Soaking the anal area in warm water for 10-15 minutes several times a day can help relieve symptoms. Cost: Minimal, only requires access to warm water.
• Oral pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can be used for pain relief. Cost: Varies depending on the specific medication and formulation.

Surgical Procedures:

• Incision and drainage: For perianal abscesses, a small incision is made to drain the pus and relieve symptoms. Cost: $500-$2000.
• Lateral internal sphincterotomy: In cases of chronic anal fissures, a small incision is made in the internal anal sphincter muscle to reduce spasm and promote healing. Cost: $1000-$3000.
• Advancement flap repair: For complex or recurrent anal fistulas, a flap of tissue is used to cover the internal opening and promote healing. Cost: $2000-$5000.

Alternative Interventions

• Warm compresses: Applying warm compresses to the anal area can help reduce pain and promote healing. Cost: Minimal, only requires access to warm water.
• Dietary modifications: Increasing fiber intake and drinking plenty of fluids can help soften the stool and prevent constipation. Cost: Varies depending on the specific dietary changes.
• Sitz baths with additives: Adding Epsom salts or baking soda to sitz baths can provide additional relief and promote healing. Cost: Minimal, only requires access to warm water and the additives.
• Herbal remedies: Some herbal remedies, such as witch hazel or aloe vera gel, may have soothing properties. Cost: Varies depending on the specific herbal product.

Lifestyle Interventions

• Good anal hygiene: Gently cleaning the anal area with mild soap and water after bowel movements can help prevent infection and promote healing. Cost: Minimal, only requires access to water and mild soap.
• Avoiding excessive wiping: Using moist wipes or a bidet can help reduce irritation and trauma to the anal area. Cost: Varies depending on the specific product.
• Regular exercise: Engaging in regular physical activity can help promote regular bowel movements and prevent constipation. Cost: Varies depending on the specific exercise routine.
• Stress management: Stress can contribute to bowel dysfunction, so finding effective stress management techniques, such as meditation or yoga, may be beneficial. Cost: Varies depending on the specific stress management technique.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – D95 Anal fissure/perianal abscess (ICD-10:K60, K61)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Anal fissure/perianal abscess effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Anal fissure/perianal abscess. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Anal fissure – NHS. (n.d.). Retrieved from https://www.nhs.uk/conditions/anal-fissure/
2. Perianal Abscess: vs. Hemorrhoid, Causes & Treatment, Surgery. (n.d.). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/23282-perianal-abscess
3. Anal fissure: diagnosis, management, and referral in primary care. (2019). British Journal of General Practice, 69(688), 554–555. https://doi.org/10.3399/bjgp19x706457
4. Anal Fissure: What It Is, Symptoms, Causes & Treatment. (n.d.). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/13177-anal-fissures
5. Anal fissure – Symptoms and causes. (2021, July 31). Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424
6. Perianal Abscess – StatPearls – NCBI Bookshelf. (2022, July 4). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK459167/
7. Anal Abscess: Symptoms, Causes, and Treatments – WebMD. (n.d.). Retrieved from https://www.webmd.com/a-to-z-guides/anal-abscess
8. Common causes of anal fissures | Vinmec. (n.d.). Retrieved from https://www.vinmec.com/vi/gastroenterology-hepatobiliary/health-news/common-causes-of-anal-fissures/?link_type=related_posts
9. Anal fissure – Better Health Channel. (n.d.). Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anal-fissure
10. Anorectal Abscess – Gastrointestinal Disorders – MSD Manuals. (n.d.). Retrieved from https://www.msdmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anorectal-abscess