Fast Five Quiz: Anal Fissures and Fistulas

Richard H. Sinert, DO


September 15, 2022

According to 2021 American College of Gastroenterology (ACG) recommendations, management of chronic anal fissures generally consists of stool softening and spasm reduction for improved regional perfusion. The ACG strongly recommends initial medical treatment of chronic anal fissure be local application of a calcium channel blocker and suggests a trial of botulinum toxin A injections in the setting of failed calcium channel blocker (CCB) therapy or as an alternative option to CCB. Another treatment option for chronic anal fissures is nitroglycerine. Lateral internal sphincterotomy is strongly recommended as the surgical treatment of choice for chronic anal fissures refractory to nonsurgical measures.

Treatment of anal fistulas depends on (1) the location of the fistula, (2) evidence of sepsis or a large abscess, or (3) worrisome findings on physical examination. If an abscess is present, drainage is indicated. Intravenous antibiotics, antipyretics, and analgesics are provided as needed. However, simple rectal abscesses do not typically need antibiotics. If the patient also has sepsis, intravenous fluids or a pressor may be necessary. Depending on the presence of systemic symptoms and the condition of the patient, surgery may be necessary. Asymptomatic anal fistulas from Crohn's disease are not managed by surgery. However, if the patient is symptomatic, surgical management should be considered.

Learn more about treating anal fissures and anal fistulas.

This Fast Five Quiz was excerpted and adapted from the Medscape articles Anal Fissure, Hemorrhoids, Anal Cancer, Fistula-in-Ano, Erythrocyte Sedimentation Rate, and Anal Fistulas and Fissures.

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