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Anal Fissures.

Amanda Chiu1, Steven Donahue1, Zachary Torgersen1

  • 1Section of Colon and Rectal Surgery, Creighton University School of Medicine, 9850 Nicholas Street Suite 100, Omaha, NE 68114, USA.

The Surgical Clinics of North America
|November 15, 2025
PubMed
Summary
This summary is machine-generated.

Anal fissures are common anorectal issues causing pain and bleeding, often linked to anal sphincter hypertonia. Management ranges from lifestyle changes to surgical interventions like lateral internal sphincterotomy.

Keywords:
Anal fissureBotulinum toxinFissure-in-anoNifedipineNitroglycerinSphincterotomy

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Area of Science:

  • Gastroenterology
  • Colorectal Surgery

Background:

  • Anal fissures are frequent anorectal conditions.
  • They commonly present with pain and bleeding.
  • Hypertonic anal sphincter is a frequent cause, but other etiologies exist.

Purpose of the Study:

  • To review the diagnosis and management of anal fissures.
  • To discuss various treatment modalities for chronic anal fissures.
  • To highlight special considerations for specific patient groups.

Main Methods:

  • Clinical diagnosis is the primary method.
  • Initial management focuses on conservative measures.
  • Chronic cases may require pharmacological or surgical treatments.

Main Results:

  • Conservative management includes increased fiber and fluid intake.
  • Pharmacological options include topical nitrates, calcium channel blockers, and botulinum toxin.
  • Lateral internal sphincterotomy is the established gold standard for surgical management.

Conclusions:

  • Anal fissures require a tailored management approach.
  • Conservative treatments are effective for many patients.
  • Surgery, particularly lateral internal sphincterotomy, offers a definitive solution for chronic or refractory cases.