Fissura anal

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Evidence last reviewed: 22 Feb 2026

Topic last updated: 22 Dec 2023

A fissura anal causa dor intensa ao defecar, geralmente descrita como "a passagem de vidro quebrado". A dor pode permanecer por 1 a 2 horas, e também pode ser em queimação.

Muitas vezes, há uma pequena quantidade de sangue vermelho vivo nas fezes, que também é visto ao limpar.

No exame físico do ânus, quase sempre há um espasmo acentuado dos músculos do esfíncter com sensibilidade significativa que, geralmente, impede o exame de toque.

O tratamento inicial deve incluir nitroglicerina ou diltiazem tópicos, juntamente com um programa de cuidados de suporte.

Fissuras resistentes ou crônicas podem se beneficiar de toxina botulínica A e, na maioria dos casos, podem ser curadas com esfincterotomia cirúrgica ou retalho de avanço anal.

Definition

A fissura anal é uma ruptura na pele do canal anal distal que se caracteriza por dor ao defecar e sangramento retal. É uma condição comum em adultos jovens e de meia-idade e pode ocorrer em 1 em 350 pessoas.[1] É a segunda complicação gastrointestinal mais comum da gravidez após as hemorroidas. A dor é descrita como intensa (geralmente, como "passagem de vidro quebrado") e causa um grande efeito negativo na qualidade de vida.[2][3][4]

History and exam

Key diagnostic factors

presença de fatores de risco
dor ao defecar
sensação de dilaceração na passagem das fezes
sangue vivo nas fezes ou no papel
espasmo anal

Full details

Other diagnostic factors

sintomas intermitentes
plicoma sentinela
fissura visível na retração das nádegas

Full details

Risk factors

fezes endurecidas
gestação
analgesia opiácea

Full details

Diagnostic tests

1st tests to order

diagnóstico clínico

Full details

Tests to consider

manometria anal
ultrassonografia anal

Full details

Treatment algorithm

ACUTE

na apresentação

fissuras resistentes

Contributors

Authors

Nivedh Paluvoi, MD

Assistant Professor of Surgery

Colorectal Surgery

Miller School of Medicine

University of Miami

Coral Gables

Disclosures

NP declares that he has no competing interests.

Acknowledgements

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.

Peer reviewers

Stephen H. Leveson, MD, FRCS

Professor

York Hospital

York

Disclosures

SHL declares that he has no competing interests.

Steven Brown, MD, FRCS

Consultant Colorectal Surgeon

Northern General Hospital

Sheffield

Disclosures

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.

Differentials
- Doença de Crohn
- Sarcoidose
- Tuberculose
More Differentials
Guidelines
- Clinical practice guideline for the management of anal fissures
- Management of benign anorectal disorders
More Guidelines
Patient information
Fissuras anais
More Patient information
Log in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer

Fissura anal

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

na apresentação

fissuras resistentes

Contributors

Authors

Nivedh Paluvoi, MD

Disclosures

Acknowledgements

Peer reviewers

Stephen H. Leveson, MD, FRCS

Disclosures

Steven Brown, MD, FRCS

Disclosures

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