Anal Fissure Guidelines

Updated: Dec 15, 2017
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Guidelines

ACG Clinical Guideline on Anal Fissure

The 2014 American College of Gastroenterology clinical guideline on the management of benign anorectal disorders made the following recommendations for anal fissure [11] :

  • Acute anal fissure - Providers should use nonoperative treatments (eg, sitz baths, psyllium fiber, and bulking agents) as the first step in therapy (strong recommendation, moderate-quality evidence)
  • Chronic anal fissure - Providers should treat chronic anal fissure with topical pharmacologic agents (eg, calcium channel blockers or nitrates) (strong recommendation, moderate-quality evidence)
  • Chronic anal fissure - Providers should refer patients who do not respond to conservative or pharmacologic treatment for local injections of botulinum toxin (strong recommendation, low-quality evidence) or internal anal sphincterotomy (strong recommendation, high-quality evidence)