Anal Fissure : Management guide

Anal Fissure Management in Primary Care

The majority of anal fissure cases can be managed effectively in primary care with conservative measures and appropriate pharmacological treatment. The approach varies based on the duration of symptoms.

Management Phase	Action	Details
Acute (<2 weeks)	Conservative Management
	Increase fluid intake	Ensure adequate hydration to soften stools.
	Treat or prevent constipation	Provide dietary advice: Adults should aim to consume 18-30g fibre per day. Refer to Appendix 1 for fibre content in commonly consumed foods. Consider bulk-forming bowel regulator if constipation is present. Fybogel® twice daily with increased water intake. Reduces length of symptoms.
	Pain Relief
	Topical creams: Consider a 1-week course of lignocaine gel. Sitz baths: Hip bath in hot water for 2-5 minutes followed by cold water for 1 minute, after bowel movement. Offer paracetamol or ibuprofen for prolonged burning pain following defecation.
Chronic (>6 weeks)	Increase fluid intake	Continue conservative measures as per the acute phase.
	High Fibre Diet	Must be combined with a bulk-forming laxative (e.g., Fybogel® BD) and a softening laxative (e.g., lactulose) for the full 8 weeks.
	Topical Treatment
	First-line pharmacological therapy is GTN (glyceryl trinitrate) rectal ointment. Prescribe GTN BD for an...

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