Anal Fissure

  • Benjamin Perakath
  • Niranjan Agarwal


Anal fissure or fissure in ano is a longitudinal tear or split in the skin covering the distal anal canal below the level of the dentate line, overlying the lower half of the internal sphincter (Fig. 4.1). It usually presents as a linear superficial ulcer in the anoderm and is characterized by excruciating sharp perianal pain associated with passage of small amounts of bright red blood per rectum and/or pruritus (Zaghiyan and Fleshner 2011).


Anal Canal Anal Fissure Internal Anal Sphincter Internal Sphincter Chronic Anal Fissure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abcarian H. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy Vs fissurectomy-midline sphincterotomy. Dis Colon Rectum. 1980;23:31–6.CrossRefPubMedGoogle Scholar
  2. Abramowitz L, Benabderrahmane D, Baron G, Walker F, Yeni P, Duval X. Systematic evaluation and description of anal pathology in HIV-infected patients during the HAART era. Dis Colon Rectum. 2009;52(6):1130–6.CrossRefPubMedGoogle Scholar
  3. Antropoli C, Perrotti P, Robino M, et al. Nifedipine for local use in conservative treatment of anal fissure: preliminary results of a multicentre study. Dis Colon Rectum. 1999;42:1011–5.CrossRefPubMedGoogle Scholar
  4. Bailey H, Beck DE, Billingham RP, et al. A study to determine the nitroglycerin ointment dose and dosing interval that best promote the healing of chronic anal fissures. Dis Colon Rectum. 2002;45:1192–9.CrossRefPubMedGoogle Scholar
  5. Brisinda G, Maria G, Sganga G, et al. Effectiveness of higher doses of botulinum toxin to induce healing in patients with chronic anal fissures. Surgery. 2002;131:179–84.CrossRefPubMedGoogle Scholar
  6. Brown CJ, Dubreuil D, Santoro L, et al. Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial. Dis Colon Rectum. 2007;50(4):442–8.CrossRefPubMedGoogle Scholar
  7. Carapeti EA, Kamm MA, Phillips RK, et al. Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects. Dis Colon Rectum. 2000;43(10):1359–62.CrossRefPubMedGoogle Scholar
  8. Casillas S, Hull TL, Zutshi M, et al. Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum. 2005;48(6):1193–9.CrossRefPubMedGoogle Scholar
  9. Cook TA, Humphreys MM, Mortenson NJ. Oral nifedipine reduces resting anal pressure and heals chronic anal fissure. Br J Surg. 1999;86:1269–73.CrossRefPubMedGoogle Scholar
  10. Dodi G, Bogoni F, Infantino A, et al. Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. Dis Colon Rectum. 1986;29(4):248–51.CrossRefPubMedGoogle Scholar
  11. Eisenhammer S. The surgical correction of chronic internal anal (sphincteric) contracture. S Afr Med J. 1951; 25(28):486–9.PubMedGoogle Scholar
  12. Fleischer M, Marini CP, Statman R, et al. Local anesthesia is superior to spinal anesthesia for anorectal surgical procedures. Am Surg. 1994;60(11):812–5.PubMedGoogle Scholar
  13. Fleshner PR, Schoetz Jr DJ, Roberts PL, et al. Anal fissure in Crohn’s disease: a plea for aggressive management. Dis Colon Rectum. 1995;38(11):1137–43.CrossRefPubMedGoogle Scholar
  14. Garcea G, Sutton C, Mansoori S. Results following conservative lateral sphincterotomy for the treatment of chronic anal fissures. Colorectal Dis Off J Assoc Coloproctol G B Irel. 2003;5(4):311–4.Google Scholar
  15. Garcia-Aguilar J, Balmonte C, Wong W, et al. Open vs closed sphincterotomy for chronic: long term results. Dis Colon Rectum. 1996;39:440–3.CrossRefPubMedGoogle Scholar
  16. Gupta PJ. Sphincterotomy with radio frequency surgery: a new treatment technique of fissure in ano and associated pathologies. Rom J Gastroenterol. 2003;12(1):37–40.PubMedGoogle Scholar
  17. Gupta PJ. Treatment of fissure in ano- revisited. Afr Health Sci. 2004;4(1):58–62.PubMedCentralPubMedGoogle Scholar
  18. Gupta PJ. Internal anal sphincterolysis for chronic anal fissure: a prospective, clinical, and manometric study. Am J Surg. 2007;194(1):13–6.CrossRefPubMedGoogle Scholar
  19. Hyman N. Incontinence after lateral internal sphincterotomy: a prospective study and quality of life assessment. Dis Colon Rectum. 2004;47(1):35–8.CrossRefPubMedGoogle Scholar
  20. Isbister WH, Prasad J. Fissure in ano. Aust N Z J Surg. 1995;65(2):107–8.CrossRefPubMedGoogle Scholar
  21. Jensen SL. Maintenance therapy with unprocessed bran in the prevention of acute anal fissure recurrence. J R Soc Med. 1987;80(5):296–8.PubMedCentralPubMedGoogle Scholar
  22. Jonas M, Neal KR, Abercrombie JF, et al. A randomized trial of oral vs. topical diltiazem for chronic anal fissures. Dis Colon Rectum. 2001;44(8):1074–8.CrossRefPubMedGoogle Scholar
  23. Kennedy ML, Sowter S, Nguyen H. Glyceryl trinitrate ointment for the treatment of chronic anal fissure: results of a placebo-controlled trial and long-term follow-up. Dis Colon Rectum. 1999;42(8):1000–6.CrossRefPubMedGoogle Scholar
  24. Klosterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure. Dis Colon Rectum. 1989;32(1):43–52.CrossRefPubMedGoogle Scholar
  25. Knight JS, Birks M, Farouk R. Topical diltiazem ointment in the treatment of chronic anal fissure. Br J Surg. 2001;88(4):553–6.CrossRefPubMedGoogle Scholar
  26. Lewis TH, Corman ML, Prager ED, et al. Long term effects of open and closed sphincterotomy for anal fissure. Dis Colon Rectum. 1988;31:368–71.CrossRefPubMedGoogle Scholar
  27. Littlejohn DR, Newstead GL. Tailored lateral sphincterotomy for anal fissure. Dis Colon Rectum. 1997;40:1439–42.CrossRefPubMedGoogle Scholar
  28. Machicado GA, Cheng S, et al. Resolution of chronic anal fissures after treatment of contiguous internal hemorrhoids with direct current probe. Gastrointest Endosc. 1997;45:157–62.CrossRefPubMedGoogle Scholar
  29. Madalinski MH. Identifying the best therapy for chronic anal fissure. World J Gastrointest Pharmacol Ther. 2011;2(2):9.PubMedCentralCrossRefPubMedGoogle Scholar
  30. Minguez M, Melo F, Espi A, et al. Therapeutic effects of different doses of botulinum toxin in chronic anal fissure. Dis Colon Rectum. 1999;42:1016–21.CrossRefPubMedGoogle Scholar
  31. Minguez M, Herreros B, Espi A, et al. Long-term follow-up (42 months) of chronic anal fissure after healing with botulinum toxin. Gastroenterology. 2002;123(1):112–7.CrossRefPubMedGoogle Scholar
  32. Nelson RL, Thomas K, Morgan J, et al. Non surgical therapy for anal fissure. Cochrane Database Syst Rev. 2012;2, CD003431.PubMedGoogle Scholar
  33. Pfenninger JL, Zainea GG. Common anorectal conditions, part II. Am Fam Physician. 2001;64(1):77–88.PubMedGoogle Scholar
  34. Rakinic CV, Boehler M, Advani V, et al. Anal fissure. Clin Colon Rectal Surg. 2007;25(3):133–7.CrossRefGoogle Scholar
  35. Recamier lCA (1829). Quoted by OH Goodsall and WE Miles. Disease of the Anus and rectum, pan 1. Longmans. London 1900.Google Scholar
  36. Richard CS, Gregoire R, Plewes EA, et al. Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group. Dis Colon Rectum. 2000;43:1048–57.CrossRefPubMedGoogle Scholar
  37. Saad AM, Omer A. Surgical treatment of chronic fissure-in-ano: a prospective randomised study. East Afr Med J. 1992;69(11):613–5.PubMedGoogle Scholar
  38. Schouten WR, Briel JW, Auwerda JJ. Ischaemic nature of anal fissure. Br J Surg. 1996;83(1):63–5.CrossRefPubMedGoogle Scholar
  39. Sohn N, Eisenberg M, Weinstein M, Lugo R, Ader J. Precise anorectal sphincter dilatation-Its role in the therapy of anal fissures. Diseases of the Colon & Rectum. 1992;35(4):322–7.CrossRefGoogle Scholar
  40. Wiley M, Day P, Rieger N. Open vs. closed lateral internal sphincterotomy for idiopathic fissure-in-ano: a prospective, randomized, controlled trial. Dis Colon Rectum. 2004;47(6):847–52.CrossRefPubMedGoogle Scholar
  41. Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg. 2011;24(1):22–30.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of Surgery Unit 2Christian Medical CollegeVelloreIndia
  2. 2.Department of General SurgeryBombay Hospital Institute of Medical Sciences Mumbai – 20MumbaiIndia

Personalised recommendations