If syphilis or chlamydial infection is in the differential, wound cultures may be necessary. If extent of underlying abscess is not known, a CT scan may be necessary to delineate its boundaries. Use WASH regimen in treatment of anal fissures. Most uncomplicated fissures resolve in 2-4 weeks with supportive care. Chronic anal fissures frequently require surgical treatment.
All surgical procedures involve stretching or cutting internal sphincter.
The most common surgical procedure is lateral internal sphincterotomy. Botulin toxin has also been used with great success for treatment of anal fissures. Administer IV antibiotics, antipyretic, and analgesic as needed. If patient is septic with hypotension, IV fluids or a pressor may be necessary. Consultation usually is not necessary for anal fissures.