Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Initial first-line treatments for anal fissures in adults focus on conservative measures to promote healing and manage symptoms NICE CKS.
- Lifestyle and Bowel Management:
- Ensure stools are soft and easy to pass through adequate dietary fibre intake (introduced gradually) and sufficient fluid intake NICE CKS.
- Advise on correct anal hygiene, keeping the area clean and dry NICE CKS.
- Discourage 'stool withholding' and undue straining during bowel movements NICE CKS.
- Pain Management:
- Offer simple analgesia such as paracetamol or ibuprofen for prolonged burning pain after defecation, avoiding opioid analgesics due to constipation risk NICE CKS.
- Advise sitting in a shallow, warm bath several times a day, particularly after a bowel movement, to help relieve pain NICE CKS.
- Topical Medications:
- For adults experiencing extreme pain on defecation, consider a short course (a few days) of a topical anaesthetic (e.g., lidocaine 5% ointment) for use before passing a stool NICE CKS. This should not be used for longer than a few days due to hypersensitivity risk NICE CKS.
- If symptoms have been present for 1 week or more without improvement, in addition to lifestyle measures, consider prescribing rectal glyceryl trinitrate (GTN) 0.4% ointment (provided there are no contraindications) to aid healing NICE CKS. Advise application twice a day for 6–8 weeks to allow re-epithelization and reduce the risk of relapse NICE CKS. Patients should be aware that headache is a common side effect NICE CKS. GTN works by relaxing the internal anal sphincter, which improves blood flow and aids healing NICE CKS.