Anal fissure

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 glyceryl trinitrate or diltiazem, along with a programme of supportive care.

Resistant or chronic fissures may benefit from botulinum toxin A, and most cases can be cured by surgical sphincterotomy or anal advancement flap.

Anal fissure is a split in the skin of the distal anal canal characterised 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]Ayatunde AA, Debrah SA. Current concepts in anal fissures. World J Surgery. 2006;30:2246-60. http://www.ncbi.nlm.nih.gov/pubmed/17102918?tool=bestpractice.com It is the second commonest gastro-intestinal complication of pregnancy after haemorrhoids. The pain is described as severe (often described as 'like passing broken glass') and has a serious negative effect on quality of life.[2]Lund JN, Scholefield JH. Aetiology and treatment of anal fissure. Br J Surg. 1996;83:1335-1344. http://www.ncbi.nlm.nih.gov/pubmed/8944447?tool=bestpractice.com [3]Collins EE, Lund JN. A review of chronic anal fissure management. Tech Coloproctol. 2007 Sep;11(3):209-23. http://www.ncbi.nlm.nih.gov/pubmed/17676270?tool=bestpractice.com [4]Gilani A, Tierney G. Chronic anal fissure in adults. BMJ. 2022 Jan 12;376:e066834.​​