Anal Fissures.

Anal fissures are a common anorectal condition typically occurring in the midline. They often present with pain and bleeding though presentation can be variable. Most fissures are associated with hypertonic anal sphincter, though other etiologies include infection, inflammatory bowel disease, and malignancy. Diagnosis is primarily clinical. Initial management involves increased fiber and fluid intake, and symptom management. Chronic fissures may require topical nitrates, calcium channel blockers, botulinum toxin, or surgery. Lateral internal sphincterotomy is the gold standard surgical management. Special considerations exist for certain patient populations.