An anal fissure is a painful linear ulcer in the surface layer of tissue in the anus (the epithelium). This condition is common and can affect the entire population. The medical treatment based on fibers, water, emollient, sitz bath and local analgesia is effective in more than 50% of cases. When the fissures are chronic, topical treatment with a calcium channel blocker (nifedipine) is usually preferred to relax the anal sphincter, before attempting a surgical approach. Surgical relaxation of the anal sphincter (a sphincterotomy) is effective up to 95% with a recurrence rate of approximately 3%. Cases that do not heal should be evaluated to discover the underlying primary problem.

D^r Mathieu Bélanger, surgeon, Child Jesus Hospital, Quebec