Clinical reference

Acute anal fissure

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

ASCRS Clinical Practice Guideline for Anal Fissure 2017 · Xyloproct (lidocaine 5%) ointment SmPC sections 4.2 and 4.4 (eMC product 883)

Verified against3 documents

ASCRS Clinical Practice Guideline for Anal Fissure 2017
Xyloproct (lidocaine 5%) ointment SmPC sections 4.2 and 4.4 (eMC product 883)
Acute anal fissure - disease-level clinical article (anal-fissure-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

Acute fissures cause severe pain during bowel movements along with minor blood streaking rather than heavy bleeding [anal pain]
Pain often continues for hours after the bowel movement is over [anal pain]
Chronic fissures cause prolonged, recurring painful defecation with intermittent rectal bleeding, often with constipation or hard stools [constipation · rectal bleeding]
Crohn disease can cause recurring anal pain tied to defecation over a long period [anal pain]

Signs — what you find (6)

An acute fissure looks like a shallow, lengthwise tear extending up from the anal opening
Both the fissure and the anal sphincter are typically very tender to touch
Chronic fissures are larger and deeper, sometimes exposing the internal sphincter muscle fibers
Repeated injury and healing leave thickened, indurated edges forming a skin tag known as a sentinel pile
The classic triad in chronic disease is a sentinel skin tag, the fissure itself, and an enlarged anal papilla
Fissures in the midline, front or back, are typical, while an off-midline location is atypical

Tests (1)

Examination under anesthesia may be used for chronic, recurring fissures to confirm the diagnosis and sometimes treat it at the same time

If not this — what else fits (6)

Hemorrhoids are the most common condition confused with a fissure
Pain is usually confined to external hemorrhoids, especially when clotted
A perianal abscess can also cause pain that worsens with defecation, sometimes with bleeding
An abscess can progress into an anal fistula with bleeding or pus discharge
Perianal ulcers from STIs, inflammatory bowel disease, or tuberculosis are additional considerations
Solitary rectal ulcer syndrome can mimic fissure symptoms and is usually found further up from the anal opening on sigmoidoscopy

SourceStatPearls "Anal Fissures" - disease-level clinical article

Presentation findings are traced to the source above.

GLYCERYL TRINITRATE

1st line

Formtopical

Adult dose and duration

Apply 0.4% ointment intra-anally every 12 hours x up to 8 weeks

Paediatric dose

Specialist pediatric surgical referral required

Dose source

ASCRS Clinical Practice Guideline for Anal Fissure 2017

Why

Topical nitrate that relaxes the internal anal sphincter and improves local blood flow, breaking the spasm-ischemia cycle that keeps a fissure from healing; used alongside fiber, stool softeners, and sitz baths rather than instead of them.

Cautions

Headache is very common due to systemic nitrate absorption.
Advise high-fiber diet, stool softeners, and warm sitz baths concurrently.
Contraindicated with PDE-5 inhibitors (sildenafil).

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
GLYCEROTONE 0.4 % RECTAL OINT. 50 GM	EGPI > MISR	32.50 EGP
RECTOSWAB RECTAL OINT 30 GM	UNISWAB	12.90 EGP

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line

Dose source

Acute anal fissure - disease-level clinical article (anal-fissure-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions

RED FLAG - An atypical (nonmidline) fissure location requires investigation for secondary underlying causes (Crohn disease, infection, malignancy).

LIDOCAINE

2nd line

Formtopical

Adult dose and duration

Apply 5% ointment topically to anal verge prior to defecation x up to 2 weeks

Paediatric dose

Specialist pediatric surgical referral required

Dose source

Xyloproct (lidocaine 5%) ointment SmPC sections 4.2 and 4.4 (eMC product 883)

Why

Topical local anesthetic that numbs the anal verge to ease the pain of defecation; provides symptomatic relief only and does not address the sphincter spasm that perpetuates the fissure.

Cautions

Symptomatic pain relief option; does not heal internal sphincter spasm.
A fissure is broken mucosa and lidocaine crosses it. Stay under about 6 g of ointment a day; past that the drug reaches the blood, and in children that has caused seizures.
Discontinue if local sensitization occurs.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FARCO-CAINE 5% OINT. 20 GM	PHARCO	4.25 EGP
LIDOSINE 5% TOPICAL OINT. 20 GM	AMRIYA	4.40 EGP
LIDOGED 5% TOPICAL GEL 15 GM	JEDCO INT. CO. FOR PHARMACEUTICALS	5.00 EGP
ULTRACAINE 5% GEL 30 GM	MEMPHIS	31.00 EGP
XYLOTOP 4% TOP. CREAM 20 GM	SIGMA	4.25 EGP
XYLOTOP 4% TOPICAL GEL 20 GM	SIGMA	5.00 EGP
LIDOCAINE 2% GEL. 20 GM	ALEXANDRIA	6.75 EGP
XYLOCAINE JELLY 2% 30 GM	ASPEN PHARMA > PHOENIX GROUP	30.80 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.