ROSH Gastrointestinal Practice Exam

What is the most appropriate initial treatment for a patient with a small tear of the anorectal mucosa?

1. Botulinum toxin

2. Nitroglycerin

3. Sitz baths, psyllium fiber, and bulking agents

4. Sphincterotomy

The correct answer is: Sitz baths, psyllium fiber, and bulking agents

The most appropriate initial treatment for a small tear of the anorectal mucosa is centered around conservative management. Sitz baths, psyllium fiber, and bulking agents are aimed at promoting healing and preventing further trauma to the area. Sitz baths help soothe the region, alleviating discomfort and promoting blood flow, which can aid the healing process. The use of psyllium fiber and bulking agents is crucial as they help create softer stools, reducing straining during bowel movements. This is important because excessive straining can exacerbate the injury or delay healing. The combination of these approaches addresses multiple aspects of care: it alleviates pain, promotes hygiene, and minimizes the risk of recurrence. Botulinum toxin and nitroglycerin are typically used in cases of anal fissures and are not first-line treatments for simple mucosal tears. Sphincterotomy, being a surgical intervention, is reserved for more severe conditions involving the anal sphincter muscle and is not appropriate as initial management for a small tear. Thus, the conservative approach of sitz baths and fiber supplements is the most logical and effective first step for managing a small tear of the anorectal mucosa.