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Anal fissure is a tear or a split in the lining of the back passage (anus) usually brought on by a bout of constipation or straining at stool.

The predominant symptom is fresh red rectal bleeding with intense sharp pain on opening bowels which can last for a few minutes as spasms of pain. ‘It feels like passing razor blades’ is a common comment from patients.


Treatment for Anal fissure:

General measures:

Stool softeners (Lactulose or laxido)

Local hygiene

Specific measures: (In sequence)

  1. Smooth muscle relaxant ointments to apply around the anus:
    Rectogesic (GTN) 0.4% ointment for acute fissure. Diltiazem 2% ointment for chronic or long standing fissures or those not helped by Rectogesic.
  2. Examination Under Anaesthesia (EUA) and injection of Botox (can be repeated).
  3. As a last resort EUA and Lateral Anal Sphincterotomy (LAS) where smooth muscle around back passage is partially divided.