It is a rupture or tear in the inner lining of the anus, usually in the middle and back.
There are many triggers, such as the passage of large hard stools through the anal canal, prolonged diarrhoea, labour, inflammatory diseases of the colon and infectious diseases (siphilis, tuberculosis).
It manifests as severe anal pain that increases during defecation and may be accompanied by blood, which typically stains the toilet paper after defecation. Sometimes it can be associated with anal itching and mucus or yellowish mucus staining.
It is diagnosed clinically by questioning and examining the area.
Most cases heal with conservative treatment: avoid constipation and hard stools by eating fibre-rich foods and keeping properly hydrated. Other medications used: laxatives, creamy local anaesthetics, petroleum jelly or hydrocortisone and zinc oxide combinations. Surgical repair may be required in severe cases.
- Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg 2011; 24:22.
- Perry WB, Dykes SL, Buie WD, et al. Practice parameters for the management of anal fissures (3rd revision). Dis Colon Rectum 2010; 53:1110.
- Elizabeth Breen, Ronald Bleday. Anal fissure: Clinical manifestations, diagnosis, prevention. UpToDate, Jun 08, 2015.
- Rizwan Ahmed, Susan L Gearhart. Diverticulosis y trastornos anorrectales frecuentes. Harrison. Principios de Medicina Interna. Volumen 2. 19ª Edición. 1971:1978
- E. Moreno-Osset, M. Mínguez Pérez, A. Benages Martínez. Enfermedades del recto y del ano. Farreras Rozman. Medicina Interna. Volumen I. Duodécima edición. 197:200.
- María García Ávila, Eva maría Aguilar Blanco, Ángel Blanco Bravo. Urgencias en proctología. Manual de protocolos y actuación en urgencias. Hospital Virgen de la Salud, Complejo Hospitalario de Toledo. Tercera edición. 2010.485:490.
