Am Fam Physician. 2024;109(2):188-189
Author disclosure: No relevant financial relationships.
Key Points for Practice
• Conservative therapy with bulking supplements and sitz baths leads to resolution of acute anal fissures in approximately one-half of patients.
• Although topical calcium channel blockers and nitroglycerin lead to resolution of approximately one-half of chronic anal fissures, topical calcium channel blockers have fewer adverse effects, such as headache.
• Botulinum toxin injections are as effective as topical therapies but can lead to transient fecal incontinence in 5% of treated patients.
From the AFP Editors
Anal fissures are linear tears that often extend from the dentate line toward the anal verge and are most often caused by trauma from constipation or diarrhea. Fissures present with tearing anal pain that is triggered by defecation and can last for hours. Bright red blood on toilet tissue may be present. Fissures occur in the anterior midline in 73% of cases, whereas lateral or multiple fissures are atypical and may suggest Crohn disease, HIV infection, hematologic malignancies, syphilis, or tuberculosis. The American Society of Colon and Rectal Surgeons has released guidelines for the treatment of anal fissures.
Subscribe
From $165- Immediate, unlimited access to all AFP content
- More than 130 CME credits/year
- AAFP app access
- Print delivery available
Issue Access
$59.95- Immediate, unlimited access to this issue's content
- CME credits
- AAFP app access
- Print delivery available
