Anal Fissure

Question 1

What is an anal fissure?

Answer 1

A tear or ulcer in the lining of the anal canal, within the anal margin.

Presents as:

• Bleeding
• Persistent pain on defication
• A linear split in the anal mucosa

Question 2

Aims of treatment

Answer 2

Relieve pain and promote healing of the fissure.

Question 3

Acute anal fissure treatment

Answer 3

• Present for less than 6 weeks -
  Treatment aimed at ensuring stools are soft and easily passed
  Laxative and either a short term topical preparation (lidocaine) or a simple analgesic (paracetamol or ibuprofen)
• Bulk forming laxatives (ispaghula husk)–recommended
• Osmotic laxative (lactulose)

Question 4

Chronic anal fissures treatment

Answer 4

• Present for 6 weeks or longer -
  GTN rectal ointment (strength does not influence the effectiveness, but higher strength potentially increases the incidence of s/e - headache)
  Recurrence of the fissure after treatment is common.