{"id":11499,"date":"2026-10-01T06:18:07","date_gmt":"2026-10-01T09:18:07","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=11499"},"modified":"2026-10-01T06:18:18","modified_gmt":"2026-10-01T09:18:18","slug":"diagnostico-de-fissura-anal-cronica-o-que-o-gastroenterologista-precisa-saber","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/cirurgia\/diagnostico-de-fissura-anal-cronica-o-que-o-gastroenterologista-precisa-saber\/","title":{"rendered":"Diagn\u00f3stico de fissura anal cr\u00f4nica: o que o gastroenterologista precisa saber"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/11499?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/11499?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<p class=\"has-pale-ocean-gradient-background has-background wp-block-paragraph\"><strong>Autores:<\/strong> Isaac Jos\u00e9 Felippe Corr\u00eaa Neto, Rodrigo Ambar Pinto, Yasmin Gois de Mello, B\u00e1rbara Theobaldo, Lucas Ambar Pinto Anjos, Carlos Frederico Sparapam Marques<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fissura anal \u00e9 uma <strong>afec\u00e7\u00e3o anorretal frequente<\/strong>, caracterizada por uma <strong>les\u00e3o linear da anoderme<\/strong>, habitualmente localizada na linha m\u00e9dia posterior, associada principalmente \u00e0 <strong>dor intensa durante ou ap\u00f3s a evacua\u00e7\u00e3o<\/strong>. Embora sua etiopatogenia n\u00e3o esteja completamente esclarecida, resulta provavelmente da intera\u00e7\u00e3o entre trauma mec\u00e2nico, altera\u00e7\u00f5es da fun\u00e7\u00e3o esfincteriana e fatores vasculares locais. \u00c9 considerada <strong>cr\u00f4nica quando persiste por seis semanas ou mais<\/strong>, podendo apresentar altera\u00e7\u00f5es morfol\u00f3gicas como plicoma sentinela, papila anal hipertr\u00f3fica, fibrose das bordas e exposi\u00e7\u00e3o das fibras do esf\u00edncter anal interno (EAI)<\/p>\n\n\n\n<h2 id=\"h-quadro-clinico\" class=\"wp-block-heading\"><strong>Quadro cl\u00ednico<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Considerar quando:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Dor durante e ap\u00f3s evacua\u00e7\u00e3o (90,8%)<\/li>\n\n\n\n<li>Sangramento anal (71,4%)<\/li>\n\n\n\n<li>Descarga anal, prurido, dispareunia<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-fatores-de-risco\" class=\"wp-block-heading\"><strong>Fatores de risco<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Constipa\u00e7\u00e3o intestinal<\/li>\n\n\n\n<li>Fezes ressecadas<\/li>\n\n\n\n<li>Diarreia<\/li>\n\n\n\n<li>Cirurgias orificiais<\/li>\n\n\n\n<li>Trauma local<\/li>\n\n\n\n<li>Dieta: baixa ingesta de fibras, p\u00e3o branco, molhos, salsicha, bacon<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-diagnostico\" class=\"wp-block-heading\"><strong>Diagn\u00f3stico<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Exame proctol\u00f3gico com inspe\u00e7\u00e3o anal, toque retal e anuscopia: s\u00e3o suficientes para o diagn\u00f3stico de fissura anal cr\u00f4nica, restando a colonoscopia mais para diagn\u00f3sticos diferenciais e rastreamento de c\u00e2ncer colorretal<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11500\"><img fetchpriority=\"high\" decoding=\"async\" width=\"603\" height=\"379\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-1-Fissura-anal.jpeg\" alt=\"\" class=\"wp-image-11500\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-1-Fissura-anal.jpeg?v=1790195230 603w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-1-Fissura-anal-300x189.jpeg?v=1790195230 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-1-Fissura-anal-585x368.jpeg?v=1790195230 585w\" sizes=\"(max-width: 603px) 100vw, 603px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 1: Fissura anal. Fonte: arquivo pessoal<\/figcaption><\/figure>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li>Manometria anorretal: exame indicado para avalia\u00e7\u00e3o da press\u00e3o anal de repouso, que em cerca de 65-70% dos casos de FAC encontra-se elevada, sobretudo para an\u00e1lise pr\u00e9-operat\u00f3ria. Al\u00e9m disso, a manometria anorretal pode fazer a sugest\u00e3o de dissinergia p\u00e9lvica associada ao quadro de fissura anal, podendo inclusive ser um fator de perpetua\u00e7\u00e3o do processo.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Diagn\u00f3sticos diferenciais:<\/strong> s\u00edfilis, gonorr\u00e9ia, Tb, clam\u00eddia, herpes, SIDA, doen\u00e7a de Crohn<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nessas situa\u00e7\u00f5es, habitualmente as fissuras s\u00e3o m\u00faltiplas e fogem da linha m\u00e9dia, notadamente da localiza\u00e7\u00e3o mais comum (posterior)<\/p>\n\n\n\n<h2 id=\"h-tratamento\" class=\"wp-block-heading\"><strong>Tratamento<\/strong><\/h2>\n\n\n\n<h3 id=\"h-objetivos\" class=\"wp-block-heading\"><strong>Objetivos:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Redu\u00e7\u00e3o do trauma anal evacuat\u00f3rio<\/li>\n\n\n\n<li>Al\u00edvio da dor<\/li>\n\n\n\n<li>Redu\u00e7\u00e3o da hipertonia esfincteriana<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-manejo\" class=\"wp-block-heading\"><strong>Manejo:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medidas gerais:<\/strong> dieta, banho de assento, aumento da ingest\u00e3o h\u00edbrica e de fibras, formadores de bolo fecal, pomadas anest\u00e9sicas, AINH<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Esfincterotomia qu\u00edmica<\/strong>\n<ul class=\"wp-block-list\">\n<li>Pontos positivos:\n<ul class=\"wp-block-list\">\n<li>Sucesso: 47 a 86%<\/li>\n\n\n\n<li>1\u00ba linha de tratamento<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Pontos negativos:\n<ul class=\"wp-block-list\">\n<li>Aplica\u00e7\u00e3o frequente<\/li>\n\n\n\n<li>Cefal\u00e9ia<\/li>\n\n\n\n<li>Taquifilaxia<\/li>\n\n\n\n<li>Dermatite<\/li>\n\n\n\n<li>Ader\u00eancia<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Medicamentos:<\/strong>\n<ul class=\"wp-block-list\">\n<li>Nitratos:\n<ul class=\"wp-block-list\">\n<li>Sucesso entre 30-65%<\/li>\n\n\n\n<li>Principal efeito colateral: cefaleia<\/li>\n\n\n\n<li>Exemplo: Dinitrato de Isossorbida<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Bloqueadores de canal de c\u00e1lcio\n<ul class=\"wp-block-list\">\n<li>Sucesso entre 60-95%<\/li>\n\n\n\n<li>Principal efeito colateral: cefaleia<\/li>\n\n\n\n<li>Exemplo: Nifedipina 0,2% ou Diltiazem 2%<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Toxina botul\u00ednica<\/strong>\n<ul class=\"wp-block-list\">\n<li>Al\u00edvio dos sintomas: 87%<\/li>\n\n\n\n<li>Cura: 73%<\/li>\n\n\n\n<li>Recorr\u00eancia: 40-55%<\/li>\n\n\n\n<li>Principal efeito adverso: IA transit\u00f3ria\ud83e\udc6a7-14% (2-3 semanas)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Cirurgia<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Fissurectomia:<\/strong>\n<ul class=\"wp-block-list\">\n<li>Sucesso: +-85%<\/li>\n\n\n\n<li>Taxa de incontin\u00eancia anal: 2%<\/li>\n\n\n\n<li>Satisfa\u00e7\u00e3o: 85-90%<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Esfincterotomia lateral interna<\/strong>\n<ul class=\"wp-block-list\">\n<li>Padr\u00e3o ouro<\/li>\n\n\n\n<li>Sucesso: 90-97%<\/li>\n\n\n\n<li>Taxa de incontin\u00eancia anal: 3-5%<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11501\"><img decoding=\"async\" width=\"606\" height=\"333\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-2-Diagnostico-de-fissura-anal.jpeg\" alt=\"\" class=\"wp-image-11501\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-2-Diagnostico-de-fissura-anal.jpeg?v=1790196488 606w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-2-Diagnostico-de-fissura-anal-300x165.jpeg?v=1790196488 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-2-Diagnostico-de-fissura-anal-585x321.jpeg?v=1790196488 585w\" sizes=\"(max-width: 606px) 100vw, 606px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 2: Enfincterotomia lateral interna. Fonte: arquivo pessoal<\/figcaption><\/figure>\n<\/div>\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Avan\u00e7o de retalho anal<\/strong>\n<ul class=\"wp-block-list\">\n<li>Sucesso: 77-85%<\/li>\n\n\n\n<li>Indicado principalmente em casos de fissura com fibrose e aus\u00eancia de hipotonia esfincteriana<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-gallery has-nested-images columns-default is-cropped wp-block-gallery-1 is-layout-flex wp-block-gallery-is-layout-flex\">\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11503\"><img decoding=\"async\" width=\"402\" height=\"537\" data-id=\"11503\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-3-Diagnostico-de-fissura-anal.jpeg\" alt=\"\" class=\"wp-image-11503\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-3-Diagnostico-de-fissura-anal.jpeg?v=1790196654 402w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-3-Diagnostico-de-fissura-anal-225x300.jpeg?v=1790196654 225w\" sizes=\"(max-width: 402px) 100vw, 402px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 3a: Avan\u00e7o de retalho cut\u00e2neo &#8211; preparo do retalho perianal. Fonte: arquivo pessoal<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11502\"><img loading=\"lazy\" decoding=\"async\" width=\"397\" height=\"549\" data-id=\"11502\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-4-Diagnostico-de-fissura-anal.jpeg\" alt=\"\" class=\"wp-image-11502\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-4-Diagnostico-de-fissura-anal.jpeg?v=1790196648 397w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Figura-4-Diagnostico-de-fissura-anal-217x300.jpeg?v=1790196648 217w\" sizes=\"(max-width: 397px) 100vw, 397px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 3b: Avan\u00e7o de retalho cut\u00e2neo &#8211; aspecto final ap\u00f3s avan\u00e7o e sutura. Fonte: arquivo pessoal<\/figcaption><\/figure>\n<\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 id=\"h-fluxograma-de-manejo-da-fissura-anal\" class=\"wp-block-heading\"><strong>Fluxograma de manejo da fissura anal<\/strong><\/h2>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><a href=\"https:\/\/gastropedia.pub\/pt\/?attachment_id=11504\"><img loading=\"lazy\" decoding=\"async\" width=\"655\" height=\"408\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Fluxograma-de-manejo-da-fissura-anal.png\" alt=\"\" class=\"wp-image-11504\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Fluxograma-de-manejo-da-fissura-anal.png 655w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Fluxograma-de-manejo-da-fissura-anal-300x187.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2026\/09\/Fluxograma-de-manejo-da-fissura-anal-585x364.png 585w\" sizes=\"(max-width: 655px) 100vw, 655px\" \/><\/a><figcaption class=\"wp-element-caption\">Figura 4: Algoritmo de tratamento da fissura anal aguda e cr\u00f4nica.\u00a0MHD: medidas higienodiet\u00e9ticas; Tto: tratamento; EAI: esf\u00edncter anal interno; IA: incontin\u00eancia anal; ELI: esfincterotomia lateral interna.<\/figcaption><\/figure>\n<\/div>\n\n\n<h2 id=\"h-conclusoes-mensagens-finais\" class=\"wp-block-heading\"><strong>Conclus\u00f5es\/mensagens finais<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Iniciar, se poss\u00edvel, com medidas cl\u00ednicas<\/li>\n\n\n\n<li>Manometria anorretal \u00e9 exame pr\u00e9-operat\u00f3rio fundamental e recomendado<\/li>\n\n\n\n<li>Sempre verificar em pr\u00e9-operat\u00f3rio se paciente apresenta sintomas de escape de fezes ou flatos e fatores de risco para incontin\u00eancia fecal, como: mult\u00edparas, idosos, cirurgias orificiais pr\u00e9vias e Diabetes Mellitus<\/li>\n\n\n\n<li>Fatores de progn\u00f3stico negativo para qualquer forma de tratamento cl\u00ednico (esfincterotomia qu\u00edmica ou toxina botul\u00ednica): tempo de hist\u00f3ria, exposi\u00e7\u00e3o de fibras do esf\u00edncter anal interno, plicoma sentinela e fibrose<\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-referencias\" class=\"wp-block-heading\"><strong>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Brillantino A, Renzi A, Talento P, et al. The Italian Unitary Society of Colon-proctology (SIUCP: Societ\u00e0 Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure. BMC Surg. 2023;23(1):311. doi:10.1186\/s12893-023-02223-z.<\/li>\n\n\n\n<li>Cross KLR, Brown SR, Kleijnen J, et al. The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure. Colorectal Dis. 2023;25(12):2423-2457<\/li>\n\n\n\n<li>Davids JS, Hawkins AT, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures. Dis Colon Rectum. 2023;66(2):190-199.<\/li>\n\n\n\n<li>Altomare DF, Binda GA, Canuti S, Landolfi V, Trompetto M, Villani RD. The management of patients with primary chronic anal fissure: a position paper. Tech Coloproctol. 2011;15(2):135-141.<\/li>\n\n\n\n<li>J\u00fanior CWS, Bacchi JAH, Sobrado LF, Guzela VR, Nahas SC, Cecconello I. Anoplasty with skin tag flap for the treatment of chronic anal fissure. Rev Col Bras Cir. 2019; 46(3):1-8<\/li>\n<\/ol>\n\n\n\n<h2 id=\"h-como-citar-este-artigo\" class=\"wp-block-heading\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background wp-block-paragraph\">Neto IJF, Pinto RA, Mello YG, Theobaldo B, Anjos LAP, Marques CFS. Diagn\u00f3stico de fissura anal cr\u00f4nica: o que o gastroenterologista precisa saber. Gastropedia 2026, Vol II. Dispon\u00edvel: <a href=\"https:\/\/gastropedia.pub\/pt\/?p=11499\" target=\"_blank\" rel=\"noopener\">https:\/\/gastropedia.pub\/pt\/cirurgia\/diagnostico-de-fissura-anal-cronica-o-que-o-gastroenterologista-precisa-saber\/<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Fissura anal cr\u00f4nica: diagn\u00f3stico, papel da manometria anorretal e op\u00e7\u00f5es de tratamento, incluindo nitratos, bloqueadores de c\u00e1lcio, toxina botul\u00ednica e cirurgia.<\/p>\n","protected":false},"author":5733,"featured_media":11506,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[24,26],"tags":[],"ano":[423],"tipo":[121],"volume":[44],"class_list":["post-11499","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirurgia","category-colorretal","ano-423","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v28.5) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Diagn\u00f3stico de fissura anal cr\u00f4nica: o que o gastroenterologista precisa saber - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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