What are the treatment options for anal fissures?

Updated: Nov 28, 2018
  • Author: Lisa Susan Poritz, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Failure of medical therapy to resolve the acute fissure is an indication for surgical intervention. The presence of a symptomatic chronic fissure is also an indication for surgery because few of these heal spontaneously.

The main contraindication to surgery for an anal fissure is impaired fecal continence, a state that could be exacerbated by surgery. This contraindication mostly applies to patients with minor incontinence (occasional seeping).

Patients with gross fecal incontinence (solid material) rarely develop fissures; however, those with irritable bowel syndrome and incontinence to liquid stool can develop fissures if they become constipated. These patients are at the most risk for surgical treatment of an anal fissure, because their typical bowel pattern is loose and harder to control.

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