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Anal Fissure

  • Chapter
Anorectal Disease

Abstract

Anal fissure is a common cause of anorectal pain and bleeding. Patient complaints typically include sharp, severe pain with defecation and post-defecatory bleeding. Diagnosis is usually made very easily based on history and simple inspection of the anorectum. Acute fissures will often heal either on their own with no specific therapy or with conservative measures, which include increased fiber and fluid intake, soaks/sitz baths, analgesics, and topical anti-inflammatory agents. Given that the pathophysiology often centers on internal anal sphincter hypertonia, medical options utilized for the management of refractory or chronic fissures are typically tailored towards reducing resting anal pressure and improving anodermal blood flow; these include topical nitrate compounds, topical calcium channel blockers, and injection of botulinum toxin. Surgical treatment is indicated for patients that fail conservative measures or have debilitating symptoms. Lateral internal anal sphincterotomy, long considered the gold standard in surgical management of anal fissure, is a highly successful procedure, though one must keep in mind the potential for postsurgical alterations in continence. The management of atypical fissures, such as those associated with Crohn’s disease and HIV infection, as well as low-pressure fissures, should be tailored to the individual patient.

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA

    Glenn Hall Jr. MD

  2. Department of Colon and Rectal Surgery, Ochsner Clinic, New Orleans, LA, 70121, USA

    Brian R. Kann MD, FACS, FASCRS

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Correspondence to Brian R. Kann MD, FACS, FASCRS .

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  1. Department of Colorectal Surgery, The Cleveland Clinic Digestive Disease Institute, Cleveland, Ohio, USA

    Massarat Zutshi

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Hall, G., Kann, B.R. (2016). Anal Fissure. In: Zutshi, M. (eds) Anorectal Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-23147-1_5

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