Anal fissure

Prescribing Notes:

• The management of anal fissures requires stool softening; the aim is to pass stools of a soft, “toothpaste-like” consistency.
• If the anal fissure does not heal with the above measures, then topical Diltiazem Hydrochloride can be used. If it still fails to settle afterwards, hospital referral should be considered.
• Topical Diltiazem works by relaxing the anal sphincter, increasing the blood supply to the fissure, and thereby aiding healing. A small (pea sized) amount should be applied to the finger and placed at the entrance to the anus. It should be used twice a day every day for 2 months. It is important to complete the full course to offer the best chance of successful healing. Two tubes of the cream (2 x 30gm) should be prescribed as these should last approximately 2 months. Patient must be reviewed after this. A second course of Diltiazem can be prescribed if the anal fissure has not completely healed after the first.
• Diltiazem is usually well tolerated but potential side effects include headaches, dizziness and itchiness or burning at the site when you use the cream. Most side effects will pass within a few days.
• Glyceryl trinitrate 0.4% ointment (Rectogesic) is the only licensed product available for treatment of anal fissure but it has been classed as ‘Not recommended’ by SMC.