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Highlights & Basics
- Anal fissure causes severe pain on defecation, often described as "like passing broken glass." The pain may continue for 1 to 2 hours and can also be burning in nature.
- A small amount of fresh red blood is often passed on the stool and is also seen when wiping.
- On examination of the anus, there is often marked spasm of the sphincter muscles, with significant tenderness often precluding digital examination.
- Initial treatment should include either topical nitroglycerin or diltiazem, along with a program of supportive care.
- Resistant or chronic fissures may benefit from injection with onabotulinumtoxinA, and most cases can be cured by surgical sphincterotomy or anal advancement flap.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
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Citations
Gilani A, Tierney G. Chronic anal fissure in adults. BMJ. 2022 Jan 12;376:e066834.
Lund JN, Nystrom PO, Coremans G, et al. An evidence-based treatment algorithm for anal fissure. Tech Coloproctol. 2006 Oct;10(3):177-80.[Abstract]
American Gastroenterological Association. American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure. Gastroenterology. 2003 Jan;124(1):233-4.[Full Text]
Davids JS, Hawkins AT, Bhama AR, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anal fissures. Dis Colon Rectum. 2023 Feb 1;66(2):190-9.[Full Text]
Menteş BB, Irkörücü O, Akin M, et al. Comparison of botulinum toxin injection and lateral internal sphincterotomy for the treatment of chronic anal fissure. Dis Colon Rectum. 2003 Feb;46(2):232-7.[Abstract]
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