Fissure-in-ano (Split)

This is a linear anal ulcer present at the anal margin usually midline at the back, sometimes at the front. The ulcer may develop after rapid evacuation with a hard stool. Sometimes a lump is felt which is swollen skin at the end of the ulcer.

Other predisposing factors are pregnancy/delivery where the fissure is usually in the front. The ulcer is at first acute and in some cases heals but in others becomes unhealed and chronic, these require treatment.


  • Anal pain during and after defeacation.
  • Anal bleeding often drops noted on the toilet paper.
  • Bowels can be disturbed secondary to the pain.
  • Lump and itch may be noticed.


  • Pain relief and stool softeners.
  • Topical GTN ointment heals 60% of fissures over 4 weeks.
  • Injection of Botox heals 70% of fissures.
  • Surgery heals 95% of fissures.

Other Treatments:
Treatment such as insertion of anal dilators can be successful but are generally not recommended due to poor success rate.

An anal ulcer that is unhealed may be a sign of Crohns disease or anal cancer, follow up is strongly recommended

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