Anal Fissure Questions & Answers

Updated: Nov 28, 2018
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Questions & Answers

Overview

What is an anal fissure?

What is the relevant anatomy in anal fissure?

What causes anal fissures?

What is the progression of initial minor tears in the anal mucosa to anal fissure?

What are commonly observed abnormalities in anal fissure?

What is the role of the posterior anal commissure in the pathophysiology of anal fissure?

What is the pathophysiology of pain in anal fissures?

What is the prognosis of anal fissure?

Presentation

What are the signs and symptoms of anal fissure?

What are the physical findings suggestive of anal fissure?

Workup

What is the role of lab studies in the workup of anal fissure?

What is the role of anoscopy in the workup of anal fissure?

Which histologic findings are characteristic of anal fissures?

Treatment

What are the treatment options for anal fissures?

What are the goals of medical therapy for anal fissure?

What is the first-line medical therapy for anal fissure?

What are recurrence rates of anal fissures?

What is second-line medical therapy for anal fissure?

What is the role of nifedipine ointment in the treatment of anal fissure?

What is the role of botulinum toxin in the treatment of anal fissure?

What is the efficacy of botulinum toxin for the treatment of anal fissure?

What guidelines have been published for the management of anal fissures?

How is lateral internal sphincterotomy performed in the surgical treatment of an anal fissure?

What is the role of surgery in the treatment of anal fissure?

What is included in preparation for anal fissure surgery?

How is sphincter dilatation performed in the surgical treatment of anal fissure?

What is included in postoperative care for anal fissure?

What are possible surgical complications from treatment of anal fissure?

What are the recurrence or nonhealing rates for anal fissures after surgery?

What is included in long-term monitoring of anal fissure?

Guidelines

What are the American College of Gastroenterology (ACG) clinical treatment guidelines for anal fissure?