CLINICAL PRACTICE GUIDELINESThe American Society of Colon and Rectal SurgeonsClinical Practice Guidelines for the Management ofAnal FissuresJennifer S.Davids,M.D..Alexander T.Hawkins,M.D.,M.P.H.2Anuradha R.Bhama,M.D.3.Adina E.Feinberg,M.D.C.M.+Michael J.Grieco,M.D.5.Amy L.Lightner,M.D.3.Daniel L.Feingold,M.D.5Ian M.Paquette,M.D.7On behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons1 Division of Colon and Rectal Surgery,University of Massachusetts,Worcester,Massachusetts2 Division of General Surgery,Section of Colon and Rectal Surgery,Vanderbilt University Medical Center,Nashville,Tennessee3 Department of Colorectal Surgery,Cleveland Clinic,Cleveland,Ohio4 Division of General Surgery,Joseph Brant Hospital,Burlington,Ontario,Canada5 Division of Colon and Rectal Surgery,New York University,New York,New York6 Division of Colon and Rectal Surgery,Rutgers University,New Brunswick,New Jersey7 Division of Colon and Rectal Surgery,University of Cincinnati,Cincinnati,Ohiohe American Society of Colon and Rectal Surgeonsthe topics covered in these guidelines.These guidelines(ASCRS)is dedicated to ensuring high-qualityshould not be deemed inclusive of all proper methods ofpatient care by advancing the science,preven-care nor exclusive of methods of care reasonably directedtion,and management of disorders and diseases of thetoward obtaining the same results.The ultimate judgmentcolon,rectum,and anus.The Clinical Practice Guidelinesregarding the propriety of any specific procedure must beCommittee is composed of society members who aremade by the physician considering all the circumstanceschosen because they have demonstrated expertise in thepresented by the individual patient.specialty of colon and rectal surgery.This committee wascreated to lead international efforts in defining qualitycare for conditions related to the colon,rectum,and anusSTATEMENT OF THE PROBLEMand develop clinical practice guidelines based on the bestavailable evidence.Although not proscriptive,these guide-The term anal fissure refers to a linear tear within the anallines provide information based on which decisions cancanal that usually extends from the dentate line towardbe made and do not dictate a specific form of treatment.the anal verge.Although this benign anorectal conditionThese guidelines are intended for use by all practitioners,is commonly encountered in practice,there is a paucityhealth care workers,and patients who desire informa-of population-level data describing its incidence.Traumation on the management of the conditions addressed byand irritation to the anal canal,often precipitated by eitherconstipation or diarrhea,can lead to development of ananal fissure.The primary symptom associated with analCMEEarn Continuing Education (CME)credit online at cme.lww.com.Thisfissures is anal pain,provoked by defecation,and mayactivity has been approved for AMA PRA Category 1 credit.last for several hours after defecation.The pai
