1.7.4 Management of anal fissures

ChoiceDrugDosage
1st choiceGlyceryl trinitrate 0.4% rectal ointment (Rectogesic®)Dose: Apply 2.5cm of ointment to anal canal every 12 hours until pain stops. Maximum duration of use 8 weeks.

Prescribing Notes

  • Management of anal fissures requires stool softening by increasing dietary fibre in the form of bran or by using a bulk-forming laxative. Note, stool softening is probably of no benefit in chronic anal fissures.
  • Short-term use of local anaesthetic preparations may help. If these measures are inadequate the patient should be referred for specialist treatment in hospital. The use of a topical nitrate may be considered.
  • In patients treated with Rectogesic® rectal ointment, the most common treatment-related adverse reaction was dose-related headache which occurred with an incidence of 57%.
  • Before considering surgery topical diltiazem 2% may be used twice daily (unlicensed product) in patients with chronic anal fissures unresponsive to topical nitrates.