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An anal fissure is a common, mostly benign, condition that can be acute or chronic. The diagnosis is usually made on history and physical examination, but further investigations are sometimes necessary. Primary fissures are usually benign and located in the posterior or anterior position. Secondary fissures are lateral or multiple and often indicate a more serious underlying pathology.
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Anorectal Disease: Anal Fissure
Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. Conservative management, using increased fiber and warm baths, results in healing of approximately half of all anal fissures. In fissures that fail conservative care, various pharmacologic and surgical options offer satisfactory cure rates. Lateral internal sphincterotomy remains the gold standard for definitive management of anal fissure. This review outlines the key points in the presentation, pathophysiology, and management of anal fissure.
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An anal fissure is a longitudinal tear of the perianal skin distal to the dentate line , often due to increased anal sphincter tone. Anal fissures are classified according to etiology e. They are typically very painful and may present with bright red blood per rectum hematochezia. Anal fissures are a clinical diagnosis based on history and examination findings. Management is primarily conservative, and includes stool softeners, analgesia , and possible local muscle relaxation; because of the risk of incontinence, surgical intervention is a last resort.
In most cases, anal fissures are a result of hard stools or constipation, as well as injury. Anal fissures can be acute lasting less than six weeks or chronic more than six weeks. A small percentage of these may occur at the anterior midline. The diagnosis of an anal fissure is primarily clinical.