1.7.4 Management of anal fissures
- 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.