Buying health services for local people

If you have recently travelled from Wuhan, China or are looking for information on the coronavirus outbreak please go to our page on coronavirus or the information on GOV.UK

en English
en English

Anal fissure – Information for GPs

Referral criteria / commissioning position

For referral to secondary care the patient should meet at least one of the following criteria:

  • suspicion of underlying cancer. For detailed advice on cancer referral see NICE Clinical Guideline 27
  • symptomatic adults whose anal fissure has persisted despite 8 weeks treatment
  • multiple, off the midline, large or irregular (atypical fissures) as these may be the manifestation of underlying disease
  • children whose anal fissures have not healed after 2 weeks

Investigations prior to referral


Information to include in referral letter

  • Details of how the patient meets the criteria
  • Treatments and interventions, current & past tried including the results,
  • Drug history (prescribed and non-prescribed)
  • Relevant past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption
en English