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Anal Fissures

An anal fissure is a longitudinal tear in the distal anal canal, usually in the posterior or anterior midline. Anal fissures may be associated with secondary changes such as a sentinel tag, hypertrophied anal papilla, induration of the edge of the fissure, and anal stenosis. A patient with multiple fissures, or whose fissure is not in the midline, is more likely to have Crohn's disease.

Treatment

High fiber foods, warm sitz baths, stool softeners (if necessary), and daily application of 1% hydrocortisone cream to the fissure

Lateral partial internal sphincterotomy is indicated when 4 weeks of medical therapy fails. It consists of surgical division.