What is the first-line treatment of anal fissure?

Anal fissure first-line management is conservative. The approach addresses both the immediate discomfort of acute pain and the underlying stool pattern that drives fissure formation and prevents healing.

Treatment goal

Soft stool consistency passed without straining.

Approach overview (partial)

First-line care combines measures to normalise stool consistency, targeted analgesia for pain, and structured toilet-habit advice — the full structured regimen is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/codi.167

Patients should be encouraged to aim for stool consistency which is soft and passed without straining.
This can be achieved using a combination of lifestyle measures (increased physical activity, weight loss, if appropriate, and adequate hydration), dietary changes (at least 30 g of fibre per day) and laxatives.
This can be in the form of acute sharp pain which may be treated with topical anaesthetic agents such as lidocaine.
In addition, patients may also experience a burning, dull perianal discomfort which may last for several hours after defaecation and may be offered nonopioid analgesics such as paracetamol with further escalation as appropriate.
Advice includes not ignoring the urge to defaecate and avoiding prolonged sitting on the toilet or straining.

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