Anal fissure

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Última revisão: 22 Jul 2025

Última atualização: 22 Dec 2023

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.

Definição

Anal fissure is a split in the skin of the distal anal canal characterized by pain on defecation and rectal bleeding. It is a common condition in young to middle-aged adults and may occur in 1 in 350 people.[1] It is the second commonest gastrointestinal complication of pregnancy after hemorrhoids. The pain is described as severe (often described as "like passing broken glass") and has a serious negative effect on quality of life.[2][3][4]

História e exame físico

Principais fatores diagnósticos

pain on defecation
tearing sensation on passing stool
fresh blood on stool or on paper
anal spasm

Detalhes completos

Outros fatores diagnósticos

intermittent symptoms
sentinel pile
fissure visible on retraction of buttock

Detalhes completos

Fatores de risco

hard stool
pregnancy
opiate analgesia

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

clinical diagnosis

Detalhes completos

Investigações a serem consideradas

anal manometry
anal ultrasound

Detalhes completos

Algoritmo de tratamento

AGUDA

on presentation

resistant fissures

Colaboradores

Autores

Nivedh Paluvoi, MD

Assistant Professor of Surgery

Colorectal Surgery

Miller School of Medicine

University of Miami

Coral Gables

Declarações

NP declares that he has no competing interests.

Agradecimentos

Dr Nivedh Paluvoi would like to gratefully acknowledge Dr John R. T. Monson, Dr John Scholefield, and Dr Jonathan Lund, previous contributors to this topic. JRTM declares that he has no competing interests. JS and JL are authors of a number of references cited in this topic.

Revisores

Stephen H. Leveson, MD, FRCS

Professor

York Hospital

York

Declarações

SHL declares that he has no competing interests.

Steven Brown, MD, FRCS

Consultant Colorectal Surgeon

Northern General Hospital

Sheffield

Declarações

SB declares that he has no competing interests.

Jan Rakinic, MD, FACS, FASCRS

Associate Professor of Surgery

Chief

Section of Colorectal Surgery

Southern Illinois University School of Medicine

Springfield

Declarações

JR is an author of a reference cited in this topic.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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. Resumo

American Gastroenterological Association. American Gastroenterological Association medical position statement: diagnosis and care of patients with anal fissure. Gastroenterology. 2003 Jan;124(1):233-4.Texto completo

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.Texto completo

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. Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

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Diretrizes
- Clinical practice guideline for the management of anal fissures
- Consensus guidelines in emergency colorectal surgery
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Folhetos informativos para os pacientes
Anal tears
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Anal fissure

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Algoritmo de tratamento

on presentation

resistant fissures

Colaboradores

Autores

Nivedh Paluvoi, MD

Declarações

Agradecimentos

Revisores

Stephen H. Leveson, MD, FRCS

Declarações

Steven Brown, MD, FRCS

Declarações

Jan Rakinic, MD, FACS, FASCRS

Declarações

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

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