Anal Fissure Guidelines

Updated: Jul 06, 2022
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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ACG Clinical Guideline on Anal Fissure

The 2021 American College of Gastroenterology (ACG) clinical guideline on the management of benign anorectal disorders made the following recommendations for chronic anal fissure [11] :

  • In general, management of chronic anal fissure consists of stool softening and spasm reduction for improved regional perfusion.
  • It is strongly recommended that initial medical treatment of chronic anal fissure be local application of a calcium-channel blocker (CCB).
  • A trial of botulinum toxin A injections is suggested in the setting of failed CCB therapy or as an alternative option to CCB. Another treatment option for chronic anal fissures is nitroglycerine.
  • Lateral internal sphincterotomy is strongly recommended as the surgical treatment of choice for chronic anal fissures refractory to nonsurgical measures.