OBJECTIVES

1. Define fissure in ano
2. Describe the symptoms of patients with fissure-in-ano including pain and bleeding.
3. Describe the physical examination of patients with fissure-in-ano.
4. Outline the principles of management of patients with fissure-in-ano, including the roles   of dietary management, topical ointments and stool softeners, and operative management (anal dilatation, internal anal sphincterotomy).

SKILLS

1. Perform a full rectal examination including inspection and digitation.
2. Perform a proctoscopy on a patient with suspected haemorrhoids and correctly interpret the appearances.
3. In a patient with intestinal obstruction demonstrate the signs of obstruction and in a patient with strangulation, demonstrate the signs of strangulation.