TY - JOUR T1 - Anal fissure: diagnosis, management, and referral in primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 409 LP - 410 DO - 10.3399/bjgp19X704957 VL - 69 IS - 685 AU - Matthew Newman AU - Mhairi Collie Y1 - 2019/08/01 UR - http://bjgp.org/content/69/685/409.abstract N2 - Anal fissures are tears of the anal mucosa. They can cause extreme pain (often up to 1–2 hours post-defaecation) and in many cases bleeding. Acute anal fissures are classified as lasting <6 weeks, whereas chronic fissures last >6 weeks. Primary fissures have no clear underlying cause. This is in contrast to secondary fissures, which are thought to be caused by another principal condition.If not treated effectively, anal fissures can lead to recurrence, infection, or abscesses. They can also lead to faecal impaction as patients avoid defaecation, not to mention the overall reduced quality of life.1 The lifetime incidence of anal fissures is estimated to be around 11%, with males and females equally at risk.2Although many anal fissures are primary fissures without any underlying cause, secondary causes should also be explored. These can include: inflammatory bowel disease;HIV/AIDS;colorectal cancerdermatological conditions such as psoriasis or pruritis ani;anal trauma (anal sex, surgery, pregnancy); andmedications, for example, opioids or chemotherapy.Examination is best performed in the lateral position, gently parting the buttocks … ER -