Diagnosis and management of anal fissures

16th May 2014 by NASGP

Diagnosis and management of anal fissures

Aimee Lettis gives us short, sharp nuggets of clinical information for sessional GPs.

I’ll cover something you will be familiar with as GPs: anal fissures, as well the new test on the block, faecal calprotectin.

Anal fissures

Maybe not the most glamorous of conditions, but a common (1 in 10 lifetime risk) and painful one! Here, I outline a recent DTB review on the non-surgical management (DTB 2013;51(9):102). But first, a quick refresher:

Aetiology

  • Acute fissures may be caused by passing a hard stool or postpartum, and most heal spontaneously
  • Chronic fissures last for > 6w and usually need treatment.
  • Occasionally fissures indicate an underlying illness such as Crohns, HIV, TB or syphilis.

Presentation

  • Main symptoms are sharp pain and bleeding on defecation, possibly with burning pain afterwards.
  • Examination should reveal a midline fissure, usually posteriorly.

Management of anal fissures

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