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Documented to be the best non-surgical option for prevention and healing of anal fissures. The most common symptoms of anal fissures are a sharp pain when you poo, often followed by a deep burning pain that may last several hours bleeding when you poo most people notice a small amount of bright red blood either in their poo or on the toilet paper when to see a gp. Anal fissure last revised in january 2017 next planned review by december 2021. An anal fissure is a tear or ulcer in the lining of the anal canal, immediately within the anal margin. 4 gtn ointment (rectogesic) is the only licensed topical gtn for anal fissure. 2 may be as effective and with fewer side-effects but it is currently unlicensed use and has to be made up by the pharmacist. For most people who develop an anal fissure, there isnt any obvious reason why. Its usually thought to happen if your anal canal has been damaged though, often as a result of a hard or painful bowel movement. Like other small cuts or tears to the skin, an anal fissure will often heal by itself within a few weeks. However, you should see your gp if you have an anal fissure as they can give you advice and medications to help ease your symptoms and allow the fissure to heal more quickly. Definition anal fissure (fissure in ano) is a chronic ulcer meaning disintegration of the surface of thelining of the anal canal resulting in an open sore that resists healing. It is vertical, the long axis is five to ten millimetres and the width is two to three millimetres. The majority are situated on the posterior (back) side of the anal canal, just inside the anal verge. Chronic anal fissures (present for 6 weeks or longer), and associated pain, may be treated with glyceryl trinitrate rectal ointment 0. 2 unlicensed (available from special-order manufacturers or specialist importing companies). Limited evidence suggests that the strength used does not influence the effectiveness, but that the higher strength potentially. Around one in 10 people experience anal fissures at some point in their life. Fissures are often caused by hard stools, but other causes include straining when passing, ibs, infection around the anus, trauma directly to the anus, anal cancer and giving birth. There are several symptoms that may indicate an anal fissure. Non-surgical treatments are recommended initially for acute and chronic anal fissures. These include topical nitroglycerin or calcium channel blockers (e. Diltiazem), or injection of botulinum toxin into the anal sphincter. Documented to be the best non-surgical option for prevention and healing of anal fissures.