Anal fissure

Abstract

Anal fissure is a painful tear or split in the distal anal canal. Most acute fissures heal spontaneously, but a proportion becomes chronic. This review article is restricted to the management of patients with chronic fissure. Chronicity is defined both chronologically and morphologically. The chronological definition is rather loose, but most surgeons would regard persistence beyond 6 weeks as a reasonable point when an acute fissure, now unlikely to heal with conservative treatment, may be considered chronic. Morphologically, the presence of visible transverse internal anal sphincter fibres at the base of a chronic anal fissure provides a more clear-cut morphological definition. Associated features exclusive to but by no means universally seen in chronic fissure include indurated edges, a sentinel pile and a hypertrophied anal papilla. © 2010 Springer-Verlag Berlin Heidelberg.