Anal fissures

K60.0-2

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

Painful small cracks just inside the anal margin, sometimes a linear ulcer.
It is often seen together with a sentinel pile or external haemorrhoids.
May cause spasm of the anal sphincter.
May cause bleeding on defaecation.

GENERAL MEASURES

Dietary advice to promote soft stools.

MEDICINE TREATMENT

Children

• Lactulose, oral, 0.5 mL/kg/dose once daily. See: paediatric dosing tool.
  • If poor response, increase frequency to 12 hourly.

Adult

• Lactulose, oral, 10–20 mL once daily.
  • If poor response, increase frequency to 12 hourly.
• Bismuth subgallate compound, ointment, topical, applied 2–4 times daily.

OR
Lidocaine 2%, cream, topical, applied before and after each bowel action.

REFERRAL

• Severe pain.
• Recurrent episodes.
• Poor response to symptomatic treatment.
• Persistent anal bleeding.