Botulinum Toxins
Calcium Channel Blockers
Crohn Disease
Fissure in Ano
Hand Strength

Anal Fissures

An anal fissure constitutes a longitudinal tear in the anoderm distal to the dentate line. Most lesions are idiopathic, solitary, and typically associated with hypertonicity of the internal anal sphincter, which reduces local perfusion, causes ischemia, delays healing, and perpetuates pain-induced spasm. Anal fissures are classified as acute when symptoms persist for less than 6 weeks and chronic when present beyond this period. Patients present with severe pain during and after defecation, bright red bleeding, and a visible posterior midline tear. Diagnosis is primarily clinical, based on history, symptomatology, and inspection of the anoderm. Initial management consists of stool softeners, fiber supplementation, sitz baths, and adequate hydration. Topical nitrates, calcium channel blockers, or botulinum toxin injections may be used to reduce sphincter tone and improve perfusion if conservative therapy fails. Refractory cases are treated with lateral internal sphincterotomy, which carries a small risk of transient incontinence. Secondary fissures are rarer, often multiple, off-midline, and characterized by an internal anal sphincter with a normal or reduced tone. Lesions are associated with Crohn disease, infection, malignancy, or trauma, including postsurgical injury. Management primarily targets the underlying cause. Prognosis depends on timely intervention and control of the primary disorder. This activity for healthcare professionals is designed to sharpen learners’ skills in evaluating and managing anal fissures. Participants will broaden their grasp of the condition’s etiology, risk factors, pathophysiology, clinical presentation, and evidence-based diagnostic and therapeutic guidelines. Strengthened competence will empower clinicians to collaborate effectively with interprofessional teams caring for affected individuals.

Credit & MOC Details

Credit information is provided by the course provider. We recommend confirming credit eligibility with the provider or your licensing board before starting the activity.