Treatment Guideline Chart
An anal fissure is a disruption of the skin at the distal anal canal.
Most fissures are seen by separating the buttocks with opposing traction of the thumbs.
Majority of fissures are located in the posterior midline of the anus.
Acute fissures are simple splits or cracks in the anoderm while chronic fissures may show secondary changes eg sentinel tag, hypertrophied anal papilla, rolled edges, fibrosis of the edges or deep ulceration with exposure of the underlying internal anal sphincter muscle within the fissure's base.

Anal Fissure References

  1. American Gastroenterological Association. American Gastroenterological Association medical position statement: Diagnosis and care of patient with anal fissure. Gastroenterology. 2003 Jan;124(1):233-234. PMID: 12512045
  2. Nelson R. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2003(4):CD003431. doi: 10.1002/14651858.CD003431.pub3. PMID: 14583976
  3. Madoff RD, Fleshman JW. AGA technical review on the diagnosis and care of patients with anal fissure. Gastroenterology. 2003 Jan;124(1):235-245. PMID: 12512046
  4. Antropoli C, Perroti R, Rubino M, et al. Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study [abstract]. Dis Colon Rectum. 1999 Aug;42(8):1011-1015. PMID: 10458123
  5. Perotti P, Bove A, Antropoli C, et al. Topical nifedipine with lidocaine ointment vs active control of treatment of chronic anal fissure: results of a prospective and randomized, double blind study [abstract]. Dis Colon Rectum. 2002 Nov;45(11):1468-1475. PMID: 12432293
  6. Orsay C, Rakinic J, Perry WB, et al. Practice parameters for the management of anal fissures [revised]. Dis Colon Rectum. 2004 Dec;47(12):2003-2007. PMID: 15657647
  7. Feldman M, Friedman LS, Sleisenger MH, eds. Sleisenger and Fordtran’s gastrointestinal and liver disease: pathophysiology/diagnosis/management. 7th ed. Pennsylvania: Saunders; 2002
  8. MedWorm
  9. Poritz, LS. Anal fissure. Jun 2004. Accessed 27 Jun 2005.
  10. Breen E, Bleday R. Anal fissure: medical and surgical management. UpToDate. 16 May 2012. Accessed 6 Mar 2014.
  11. Perry WB, Dykes SL, Buie WD, Rafferty JF; Standards Practice Task Force of the American Society of Colon and Rectal Surgeons. Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum. 2010 Aug;53(8):1110-1115. doi: 10.1007/DCR.0b013e3181e23dfe. Accessed 06 Mar 2014. PMID: 20628272
  12. Bhatt S, Parmar HD, Vasava N, Shah R. Comparative study of local calcium channel blocker application and lateral internal sphincterotomy in the treatment of chronic anal fissure: study of 50 cases. Int J Med Sci Public Health. 2013;2(2):434-438. doi: 10.5455/ijmsph.2013.2.460-464. Accessed 13 Jun 2014.
  13. Bleday R. Anal fissure: medical management. UpToDate. 08 Nov 2017.
  14. Stewart DB Sr, Gaertner W, Glasgow S, et al. Clinical guideline for the management of anal fissures. Dis Colon Rectum. 2017 Jan;60(1):7-14. doi: 10.1097/DCR.0000000000000735. PMID: 27926552
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