Anal Fissure

Tear in the mucosa of the anal canal, just inside the anal margin

Aetiology

  • Usually due to passage of a constipated stool
  • Multiple fissures may be due to Crohn’s disease

Clinical presentation

Symptoms

  • Acute onset of severe anal pain usually following an episode of constipation
  • Pain lasts for up to 30 mins after defecation
  • Bright red rectal bleeding

Signs

  • The fissure can be seen on external examination of the anus - usually in the midline posteriorly but may occasionally be anterior

Investigations

  • Diagnosis is clinical and further investigation is only required if there are features of underlying pathology

Management

  • Treatment usually involves dietary advice, an anesthetic cream and a stool softener
  • Pharmacological sphincterotomy (GTN, diltiazem) may be used
  • Chronic – lateral sphincterotomy, Botox injection