Anal Fissures
Description General Measures Medicine Treatment Referral ICD-10 code: K60.0-2 DESCRIPTION Painful small cracks just inside the anal margin, sometimes a linear ulcer. It is often seen together with a sentinel pile or external haemorrhoids. These may cause spasm of the anal sphincter, or bleeding on defaecation. GENERAL MEASURES Dietary advice to promote soft stools. MEDICINE TREATMENT Children Lac
ICD-10 code: K60.0-2
DESCRIPTION
Painful small cracks just inside the anal margin, sometimes a linear ulcer. It is often seen together with a sentinel pile or external haemorrhoids. These may cause spasm of the anal sphincter, or bleeding on defaecation.
GENERAL MEASURES
- Dietary advice to promote soft stools.
MEDICINE TREATMENT
Children
- Lactulose, oral, 0.5 mL/kg/dose once daily. See dosing tables.
- If poor response, increase frequency to 12 hourly.
Adult
- Lactulose, oral, 10–20 mL once daily.
- If poor response, increase frequency to 12 hourly.
AND
- Bismuth subgallate compound, ointment, topical, applied 2–4 times daily.
AND
Topical anaesthetic:
- Lidocaine 2%, cream, topical, applied before and after each bowel action.
OR
- Amethocaine 1% topical, applied before and after each bowel action.
REFERRAL
- Severe pain.
- Recurrent episodes.
- Poor response to symptomatic treatment.
- Persistent anal bleeding.
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Primary Healthcare, 2020-4_Version 1_June 2024
Chapter 2: Gastro-Intestinal Conditions, 2.5 Anal Conditions, 2.5.1 Anal Fissures