Skip to main content

Anal Fissure

Anne Walsh, MMSc, PA-C, DFAAPA and Lisa Hertz, M.D. Reviewed 04/2024
 


BASICS

DESCRIPTION

Anal fissure (fissure in ano): longitudinal tear in the lining of the anal canal distal to the dentate line, most commonly at the posterior midline; characterized by a knifelike tear...

DIAGNOSIS

HISTORY

  • Severe, sharp rectal pain, often with and following defecation but can be continuous; bright red blood on the stool or when wiping

  • Occasionally, anal pruritus or perianal irritation

PHYSICAL EXAM

TREATMENT

The goal of treatment is to avoid repeated tearing of the anal mucosa with resultant spasm of the internal anal sphincter by decreasing the patient’s high sphincter tone and addressing its u...

ONGOING CARE

DIET

High fiber (>25 g/day; augment with daily fiber supplements); increase fluid intake, decrease caffeine

PATIENT EDUCATION

  • Avoid prolonged sitting or straining during bowel movements...

REFERENCES

1
Stewart DB  Sr, Gaertner  W, Glasgow  S, et al. Clinical practice guideline for the management of anal fissures. Dis Colon Rectum.  2017; 60(1): 7– 14.  [View ...

ADDITIONAL READING

  • Fargo  MV, Latimer  KM. Evaluation and management of common anorectal conditions. Am Fam Physician.  2012;85(6):624–630. PMID:  [View Abstract] ...

CODES

ICD10

  • K60.2 Anal fissure, unspecified

  • K60.0 Acute anal fissure

  • K60.1 Chronic anal fissure

SNOMED

  • 30037006 Anal fissure (disorder)

  • 197151007 Acute anal fissure (disorder)

  • 197152000 Chronic anal fissure ...

CLINICAL PEARLS

  • Avoid anoscopy or sigmoidoscopy initially unless necessary for differential diagnoses (e.g., secondary fissures).

  • Best chance to prevent recurrence is to treat the underlying cause (e.g...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

 
×