Anal fissure

Question 1

What are anal fissures?

Answer 1

Longitudinal or elliptical tears of the squamous lining of the distal anal canal.

Question 2

Where do anal fissures most commonly occur?

Answer 2

On the posterior midline

(90%)

Question 3

What is the difference between an acute or chronic anal fissure?

Answer 3

<6 weeks = acute

>6 weeks = chronic

Question 4

What is the management of an acute anal fissure?

Answer 4

• Dietary advice: high-fibre diet with high fluid intake
• Bulk-forming laxatives are first line. Second line- Lactulose.
• Lubricants such as petroleum jelly may be tried before defecation
• Topical anaesthetics
• Analgesia

NOTE - topical steroids do not provide relief.

Question 5

What is the management of chronic fissures?

Answer 5

• The above techniques should be continued (Treat as per acute)
• Topical glyceryl trinitrate (GTN) is first line treatment for a chronic anal fissure
• If topical GTN is not effective after 8 weeks then secondary referral should be considered for surgery or botulinum toxin.

Question 6

How do anal fissures present?

Answer 6

• Sharp pain on defecation
• Burning pain lasting a few hours after
• Bleeding during and after passage of stool