Digestive_ColonRectumAnus_slide12.pdf - Documentation...

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1 Documentation Dissection SUBJECTIVE: Ms. X is here for follow up for a chronic anterior midline anal fissure. During her last visit one month ago I recommended that she try diltiazem cream as well as Kondremul. She reports that her bleeding has completely resolved but she still has some pain with bowel movements. Her pain is less than it was prior to seeing me. She is pre-approved to undergo anal Botox. She would like to avoid surgery at all costs since she has read that fecal incontinence rates can be as high as 30% |1| . PHYSICAL EXAMINATION: CONSTITUTIONAL: She is quite pleasant and appears well. VITAL SIGNS: T 98.8, HR 75, BP 124/76, Weight 237 pounds. RECTAL: Visual inspection of the anus in the prone jackknife position |2| reveals a sentinel skin tag in the anterior midline unchanged from her prior examination. Underlying the sentinel skin tag is a deep chronic fissure |3| in the anterior midline with heaped up edges also unchanged from her prior examination. Palpation of the fissure is mildly tender.
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  • Spring '19
  • NONE
  • anal fissure

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Christopher Reinemann
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