Anal Fissures Lecture for USMLE
An anal fissure is a tear in the lining of the anus or anal canal the opening through which stool passes out of the body. The fissure can be painful and may bleed. Anal fissures can occur in anyone at any age. The chance of having an anal fissure decreases as people get older. People who have had fissures in the past are more likely to have them in the future. Anal fissures can be caused by trauma to the anus and anal canal.
Anal fissure. American Society of Colon and Rectal Surgeons. Wald A, et al. American Journal of Gastroenterology. Breen E, et al. Anal fissure: Clinical manifestations, diagnosis, prevention. Ferri FF. In: Ferri's Clinical Advisor Brady JT, et al. Treatment for anal fissure: Is there a safe option? The American Journal of Surgery. Nelson RL, et al. Non surgical therapy for anal fissure. Cochrane Database of Systematic Reviews. Cook AJ. AllScripts EPSi. Rochester, Minn. Anoscopy and sigmoidoscopy.
Merck Manual Professional Version. Accessed Nov. Rajan E expert opinion. Mayo Clinic, Rochester, Minn. Mayo Clinic in Rochester, Minn. But it's limited to things like "Gee, those are nice tits. Never do this! No matter what they tell you! No matter how hard they plead and cajole. Believe me, death is preferable.
What happened to me next was this: A doctor snaked a 60 cm fiber optic hose up my fundament. It had a viewing scope on one end, and a device to pump air into my colon on the other. As he manipulated it up my rectum I could feel the head move through the colon. I could imagine the bright light moving through the labyrinth of sphincters and valves.
It reminded me of a motorcycle headlight racing through the Holland tunnel. The searing pain was intense. At one point in time, I felt as if the thing was pressing on my lungs.
I definitely felt it try to enter something that I was sure was some kind of door to my stomach. At that moment, I began to sweat profusely. The world began to spin. My stomach tried to retch, but again, nothing to barf. There I was, lying naked on a cold table with a scope up my air filled colon trying to spew when a plan for revenge crept into my mind.
With all my might I pressed my diaphragm down into the pressurized shit chamber. A tremendous wet fart sang around the hose and out my asshole. It was accompanied by the overwhelming stench of impacted fecal matter.
A small smile crossed my lips. The doctor and nurse pretended as though nothing had happened. It was only seconds later though that the tube was retracted and the nurse had to wipe my liquishit smeared rectum. I'm afraid that I have neglected my duties by not telling you about it sooner. But I have been at some loss for words about it.
After the violent anal dilation I had expected to awaken from my anesthetized slumber to find that Bob had been completely destroyed.
Annihilated by modern medicine in a small sterile room of a hospital in Seinajoki Finland. A rich heritage of blood and pain wiped out in minutes by strangers in mask and gown. It all started a couple of Mondays ago at 7 am. I hadn't slept much the night before. Bob was quiet, but I lay awake thinking about what was to come the next morning. I was a little worried.
I was about to experience something called violent anal dilation and I was a bit concerned. I found out later that my fears about the procedure where in fact pretty close to reality. I arrived at the hospital in good spirits. I was shown my bed and given the button up the back surgical minidress. Even though the procedure wasn't scheduled until I was required to change into the garment.
I suppose that it's a mandatory indignity to humiliate and degrade potential troublemakers.
Maybe word had gotten out that I had been asking questions about the procedure. What kind of drugs that they would be giving me, if my physician had performed many of these procedures etc. Medical personnel here don't like being quized by foreigners with anal fissures.
It had taken lots of explaining just to get permission to have a video taped documentary of the procedure made and released to me. I had to get my local practitioner to request it. It has since been explained to me that most procedures are taped anyway. They just don't release the tapes to the public. I was in bed dozing when I felt a sharp pain in my ass. I whirled my head around in bed to see a rather stern and matronly looking woman with a large enema bag.
Presumably it was her and her nozzle 'o fun that was causing the distress. I admired her technique. I was asleep. She probably figured that I would sleep right through it. What, and miss all the fun? Not likely. Besides, she was about as gentle as a bull elephant. Anal fissure Bob let out a sharp cry of pain.
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And so did I. She smiled and patted my head like a lap dog as she filled my rectum. As I looked around the room, I realized that we were not alone. Not 10 feet away was the wife and 2 teenage daughters of the varicose vein strip down in the bed next to me. They were all checking me out. I smiled my best grimace and tried to enjoy myself.
Anal fissure bob
At my doctor dropped by for a chat. The first thing that I noticed about him was that the hand that he extended in greeting had a slight palsy. Actually, it was more of a tremor. This is true! We chatted about the usual stuff I'm trying to ask the guy about the procedure when out of the blue, he looks up and says "We will tear you a new asshole. By this time, I am not feeling very confident about what's going on and am giving some serious thought to just getting up and leaving.
I knew about A. He was something that I could understand. I could live with him.
This surgeon was something else. An unknown X with a license to dilate. He gave me two tiny white pills to swallow. Hmmmm this guy was starting to speak my language, maybe this wouldn't be so bad after all. I began feeling a little light headed from whatever drug it was that he had given me when two orderlies came in.
They clucked low and softly to me in Finnish. Who knows what they were talking about. I just kept nodding my head stupidly. I couldn't have answered them anyway as my tongue was stuck to the roof of my parched mouth. As they rolled me down the hall I tried to count the number of acoustic tiles in the ceiling. Eventually, we arrive at the big swinging doors of the operating room and are met by two others in surgical greens. It was like a prisoner exchange at the Rhine. They greeted each other.
The two that transported me there wish me a happy dilation, hand over my file to the others, then turn and leave me with the dilation team.
As we enter the operating theatre I begin to feel quite apprehensive. My tongue is thick in my mouth.
I am transferred to the main operating table. The anesthetist walks in and without so much as a hello started tapping my forearm to find a suitable vein. I try to greet him but all that comes out is a horrible sqwak.
Tight muscles and Anal fissures
I am relieved of my meager garment and I lay there, alone and naked. I look down in horror to see that my penis and testicles have completely withdrawn into my abdomen. Perhaps they had seen it first and were trying to warn me because there, on a stainless steel tray, nestled amongst strange looking devices is the object of my apprehension. It is some sort of anal battering ram. It is stainless steel and is about a foot long. It has two handles bolted to it.
And for all the world it looked like one of those Stanley thermoses. By this time, a vein had been found and been hooked up to the Anesthetist.
He still hasn't said anything so I find my voice. No more problems. I chuckle at the prospect of the stainless invader. As this all was happening, the nurses were quite busy. They had stainless steel poles that they were affixing to the sides of the operating table. On top of these poles were large plastic blocks that were deeply indented to accommodate what could only be my thighs.
A more compromising version of the stirrups that doctors often use to examine women.
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And truly, the video has born my theory out. My butt ring is bright, exposed, and nearly eye level to the wielder of the dilation tool.
The chief dilator strolls in, and nods at the anesthetist. The latter hooks up a large syringe full of what looked like Vaseline to my I. I couldn't. I remember having a monster head rush and trying to speak. That's the last thing that I remember. It's only now that I review the video tape that I realize the horror of what actually happened to me.
It's strange to see yourself lying on a cold slab, your penis retracted, falling unconscious. Right after I go out, a nurse puts a black rubber mask over my face. Two attendants raise my thighs into the "stirrups" and scrunch me down so that my ankles are bent straight back towards my head. The camera angle is from straight overhead, so you get a weird out of body feeling watching the whole thing. One nurse manipulates what's left of my genitalia out of the way while another unceremoniously paints my asshole with some sort of red tinted disinfectant.
The doctor wastes no time and before you can say "Is he asleep?
Feb 22, One sign of an anal fissure is pain during or after a bowel movement. Causes, diagnosis and treatment-including surgery-are discussed. Appointments Bob has become a holy terror of an anal fissure and my surgeon has informed me that the most effective way of dealing with Bob is a form of surgical exorcism that is know to the medical profession as; VIOLENT ANAL DILATION. The most common location for an anal fissure in both men and women (90of all fissures) is the midline posteriorly in the anal canal, the part of the anus nearest the spine. Fissures are more common posteriorly because of the configuration of the muscle that surrounds the anus.
He checks around and during the examination gives my prostate a mighty push. I swear that I shoot a load of something straight onto my belly where it just sits there through the rest of the procedure. The doctor gives a grunt of satisfaction and reaches for the dilator.
Nurses squirt some kind of lubricant from a large syringe into and around my ass. The surgeon then inserts the end of the dilation unit into my ass and begins rotating it left and right. Soon he had my poor asshole fully dilated. There I am out like a light with a stainless steel thermos up my ass.
Every thirty seconds or so the doctor does a with the thing. This is the best part of the video. A satisfied nod and the nurses move in for the clean up.
Someone has the presence of mind to wipe the manually ejaculated fluid off of my belly. Someone swabs the shit and blood from my ass. I get another syringe of something in my arm. The mask comes off my face.