Anal Fissure

 Advice 

• Advise increase fluid intake and adequate dietary fibre intake by eating a balanced diet containing whole grains, fruits, and vegetables, gradually to minimize flatulence and bloating.
• Keep anal region clean and dry to aid healing and avoid complications of anal fissure (such as infection or abscess)

• Children: If not resolved after 2 weeks or if a lot of pain seek specialist advice/refer to a paediatrician

 First-Line

• Paracetamol or ibuprofen. Avoid opioid analgesics as they can cause constipation
• Sitting in a shallow, warm bath several times a day may help 
• topical anaesthetic (lidocaine 5% ointment) apply 1–2 mL when required before passing a stool

Second-Line

• Rectal glyceryl trinitrate (GTN) 0.4% ointment twice a day for 6–8 weeks
  • Only prescribe if symptoms for 1 week or more without improvement
  • Around 25% of people experience headache as a side effect
  • Avoided in children, and during pregnancy and breastfeeding
  • If anal fissure unhealed after 6–8 weeks but the person is asymptomatic or has had notable symptomatic improvement, consider a second course of rectal GTN
  • Refer to colorectal surgery

Patient Information 

Anal Fissure - NHS

• • If at any time an anal fissure appears atypical or scarring or skin tags develop — refer to secondary care for further investigation and management.