Anal fissure

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Última revisão: 12 Dec 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

Disclosures

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

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

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. Abstract

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

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.Full text

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. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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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

Disclosures

Peer reviewer acknowledgements

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Patient information

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice