Anal fissure: diagnosis, management, and referral in primary care

Abstract

Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 1–2 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting 6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition. If not treated effectively, anal fissures can lead to recurrence, infection, or abscesses. They can also lead to faecal impaction as patients avoid defaecation, not to mention the overall reduced quality of life.1 The lifetime incidence of anal fissures is estimated to be around 11%, with males and females equally at risk.2 Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: Examination is best performed in the lateral position, gently parting the buttocks …