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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

None

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
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