Operative procedures for anal fissure

NICE Quality and Productivity Case Studies
Queen's University Belfast
Publication date:
20 August 2015



Anal fissure is an ulcer of the skin that lines the anus, causing pain on defecation. A number of procedures have been trialled for treatment of this condition, including manual anal stretch and sphincterotomy. Manual anal stretch has a higher risk of fissure persistence than internal sphincterotomy and a significantly higher risk of minor incontinence than sphincterotomy. This Cochrane review therefore suggests there is no evidence to support the ongoing use of this procedure.