Therapy and long-term outcomes of acute anal fissure - a high-volume referral centre experience with 623 patients

Sep 30, 2026

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Acute anal fissure is a frequent cause of severe anorectal pain, with topical calcium channel blockers or glyceryl trinitrate as standard therapy, yet evidence on healing rates and long-term results remains limited. This retrospective single-centre study analyzes consecutive patients treated between January and December 2016, emphasizing long-term follow-up, complete healing, and recurrence. Outcomes include healing proportion, need for fissurectomy, follow-up duration distribution, and risk of recurrent disease.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Background

Materials and methods

Inclusion criteria

Exclusion criteria

Techniques in Coloproctology (2025) 30:14 [https://doi.org/10.1007/s10151-025-03238-9](https://doi.org/10.1007/s10151-025-03238-9) Therapy and long‑term outcomes of acute anal fissure: a high‑volume referral centre experience with 623 patients S. Fritz1,2 · J. Kirsch1 · N. Schneider1,2 · J. Kirsch1 · C. Reissfelder2 · A. Herold1,2 · D. Bussen1,2 Received: 23 January 2025 / Accepted: 8 October 2025 / Published online: 6 January 2026 © The Author(s) 2025 Abstract Background Acute anal fissure is a common cause of severe pain in the anorectal region. The standard treatment is the topical application of a calcium channel blocker or glyceryl trinitrate. Despite acute anal fissure being a common proctologic condition, data on the healing rates and long-term outcomes remain scarce. This study aimed to evaluate data from our centre, with a special focus on long-term follow-up and recurrent disease. Methods All consecutive patients who presented with acute anal fissure between January 2016 and December 2016 were retrospectively identified. Patients were included if their clinical symptoms lasted for less than 6 weeks, secondary changes to fissure morphology were absent, and data from follow-up examinations were available. Clinical features, symptoms, therapy and long-term outcomes were evaluated. Results A total of 623 patients with a median age of 45 years were included; 342/623 patients were female (54.9%) . The median follow-up period was 41 months (range 6 weeks–89 months), and 39.5% of the patients had a follow-up duration exceeding 5 years. Most fissures occurred in the 6 o’clock lithotomy position (63.7%), in the 12 o’clock position (21.0%), orin both (4.5%). In 67/623 patients, the fissure was in an atypical region (10.8%) . In 439/623 patients, the fissure healed completely (70.5%). A total of 8.7% of the patients underwent fissurectomy, and 180/623 patients experienced recurrence (28.9%) . Conclusions The management of acute anal fissure can be challenging because recurrence is common. Conservative management is successful in the majority of cases. Surgery is necessary only for a minority of patients. Keywords Acute anal fissure · Therapy · Conservative management · Outcome · Long-term outcome Background Acute anal fissure is characterized by a longitudinal tear in the anoderm, typically in the posterior midline of the anal canal and distal to the dentate line [1, 2] . Anal fissure is a common condition and is frequently the cause of severe pain and bleeding in the anorectal region [2, 3] . Systematically collected data on the precise incidence and prevalence are not available [4] . The lifetime incidence of anal fissures is estimated to be approximately 11%[1, 5–7] . Trauma or irritation to the anal canal, for example precipitated by either * S. Fritz [stefan.fritz@enddarm-zentrum.de](stefan.fritz@enddarm-zentrum.de) 1 Deutsches End-und Dickdarmzentrum, Bismarckplatz 1, 68165 Mannheim, Germany 2 Department of Surgery, Medical Faculty Mannheim, Universitätsmedizin Mannheim, Heidelberg University, Mannheim, Germany constipation or diarrhoea, is thought to cause acute anal fissures [8] . The most commonly observed abnormalities in affected patients are hypertonicity and later hypertrophy of the internal anal sphincter, leading to local ischaemia that prevents the fissure from healing [9, 10] . This condition may ultimately result in a chronic anal fissure [4] . The standard treatment for acute anal fissures is the topical application of a calcium channel blocker or glyceryl trinitrate [1, 11–13] . Nonoperative management of acute anal fissures is consid ered safe and should be the first-line treatment [8, 14] . Despite acute anal fissure being a common proctologic condition, data concerning the exact initial clinical presentation and long-term course of the disease are lacking [15, 16] . All current national guidelines indicate that the evidence in this field is generally poor [1, 8, 17] . Even

FAQs

What was the aim of this study on acute anal fissure?

To evaluate centre data with a special focus on long-term follow-up and recurrent disease, including risk factors for recurrence.

How were patients selected for inclusion and follow-up?

Consecutive patients with acute anal fissure from January–December 2016 were retrospectively identified and included when symptoms lasted less than 6 weeks and follow-up data after at least 6 weeks were available.

What were the main outcome findings regarding healing and recurrence?

Among 623 patients, 70.5% had complete healing. Recurrence occurred in 28.9% of patients, and 8.7% underwent fissurectomy.

Sep 30, 2026

Upload by Rowan