Anal Fissures David B
CLINICAL PRACTICE GUIDELINES Clinical Practice Guideline for the Management of Anal Fissures David B. Stewart, Sr., M.D. • Wolfgang Gaertner, M.D. • Sean Glasgow, M.D. John Migaly, M.D. • Daniel Feingold, M.D. • Scott R. Steele, M.D. Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons he American Society of Colon and Rectal Surgeons anal fissures is anal pain, which is often provoked by def- is dedicated to ensuring high-quality patient care ecation and may last for several hours following defecation. Tby advancing the science, prevention, and manage- Anorectal bleeding may also be associated with fissures, ment of disorders and diseases of the colon, rectum, and and, when this symptom is present, it can contribute to a anus. The Clinical Practice Guidelines Committee is com- misdiagnosis of symptomatic hemorrhoids. In up to 90% of posed of society members who are chosen because they cases, the anal fissure is located within the posterior midline have demonstrated expertise in the specialty of colon and of the anal canal. Fissures are located in the anterior midline rectal surgery. This committee was created to lead interna- in as many as 25% of female patients and in as many as 8% tional efforts in defining quality care for conditions related of male subjects. In 3% of patients, fissures can be located to the colon, rectum, and anus. This is accompanied by at posterior and anterior positions simultaneously. Fissures developing clinical practice guidelines based on the best located at lateral locations within the anal canal, and multi- available evidence.
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