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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Guidelines

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.