A painful problem: the management of anal fissures and haemorrhoids in primary care

CPD

Chloe Hava

26 February 2000

References

Higuero T. Update on the management of anal fissure. J Visc Surg. 2015;152(2 Suppl):S37–S43.
Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27(2):215–220.
Vitton V, Bouchard D, Guingand M, Higuero T. Treatment of anal fissures: results from a national survey on French practice. Clin Res Hepatol Gastroenterol. 2022;46(4):101821.
Schlichtemeier S, Engel A. Anal fissure. Aust Prescr. 2016;39(1):14–17.
Zaghiyan KN, Fleshner P. Anal fissure. Clin Colon Rectal Surg. 2011;24(1):22–30.
Newman M, Collie M. Anal fissure: diagnosis, management, and referral in primary care. Br J Gen Pract. 2019;69(685):409–410.
Lyle V, Young C. Anal fissures: an update on treatment options. Aust J Gen Pract. 2024;53:33–35.
Therapeutic Guidelines Limited. Haemorrhoids. Melbourne: Therapeutic Guidelines Limited; 2022. Available from: https://www.tg.org.au
Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009–2017.
Sandler RS, Peery AF. Rethinking what we know about hemorrhoids. Clin Gastroenterol Hepatol. 2019;17(1):8–15.
Zheng T, Ellinghaus D, Juzenas S, Cossais F, Burmeister G, Mayr G, et al. Genome-wide analysis of 944 133 individuals provides insights into the etiology of haemorrhoidal disease. Gut. 2021;70(8):1538–1549.
Therapeutic Guidelines Limited. Functional constipation in adults. Melbourne: Therapeutic Guidelines Limited; 2022. Available from: https://www.tg.org.au
Quek HW, Reus X, Lee K, Etherton-Beer C, Page A; Guideline Development Group. Deprescribing in older people: a clinical practice guideline. Perth (WA): The University of Western Australia; 2025.
Stewart D. Anal fissure: clinical manifestations, diagnosis, prevention. UpToDate. 2025. Available from: https://www.uptodate.com/contents/anal-fissure-clinical-manifestations-diagnosis-prevention
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Sadeghi A, Biglari M, Forootan M, Adibi P. Solitary rectal ulcer syndrome: a narrative review. Middle East J Dig Dis. 2019;11(3):129–134.
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Therapeutic Guidelines Limited. Anal fissure. Melbourne: Therapeutic Guidelines Limited; 2022. Available from: https://www.tg.org.au
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8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

8.00 am	Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock.
9.00 am	Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity.
10:30 am	Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together.
12.00 pm	Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles.
2.00 pm	Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing.
3.30 pm	Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines.
6.00 pm	Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses.
8.00 pm	Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track.

Knocking on doors

A workforce running on goodwill

The cost of saying no

Let pharmacists do what they are trained to do

Reform that matches need with value

How did you specialise in assisted reproductive therapy?

What does the role entail?

How do you help patients navigate their medicines regimen?

How do you manage medicines storage, cold-chain and supply?

How do you collaborate with fertility clinics, prescribers and nurses?

What advice do you have for ECPs keen on specialising in this area?

A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia

Compliance is key

Dispensing psychedelics safely

Managing patient enquiries

How does the nasal spray differ from EpiPen?

Can it be placed in a resuscitation kit?

Who is the nasal spray best suited to?

What should pharmacists know about its use?

Who is most likely to experience adverse effects?

Who might find it hard to use the nasal spray?

Could adrenaline nasal spray (neffy) be downscheduled?

How much does it cost?

Will the nasal spray be PBS listed?

Where can I find more information?

Bridging the gap when CBT is delayed

Checking duration against intention

Monitoring efficacy and tolerability

Knocking on doors

A workforce running on goodwill

The cost of saying no

Let pharmacists do what they are trained to do

Reform that matches need with value

How did you specialise in assisted reproductive therapy?

What does the role entail?

How do you help patients navigate their medicines regimen?

How do you manage medicines storage, cold-chain and supply?

How do you collaborate with fertility clinics, prescribers and nurses?

What advice do you have for ECPs keen on specialising in this area?

A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia

Compliance is key

Dispensing psychedelics safely

Managing patient enquiries

How does the nasal spray differ from EpiPen?

Can it be placed in a resuscitation kit?

Who is the nasal spray best suited to?

What should pharmacists know about its use?

Who is most likely to experience adverse effects?

Who might find it hard to use the nasal spray?

Could adrenaline nasal spray (neffy) be downscheduled?

How much does it cost?

Will the nasal spray be PBS listed?

Where can I find more information?

Bridging the gap when CBT is delayed

Checking duration against intention

Monitoring efficacy and tolerability

Knocking on doors

A workforce running on goodwill

The cost of saying no

Let pharmacists do what they are trained to do

Reform that matches need with value

How did you specialise in assisted reproductive therapy?

What does the role entail?

How do you help patients navigate their medicines regimen?

How do you manage medicines storage, cold-chain and supply?

How do you collaborate with fertility clinics, prescribers and nurses?

What advice do you have for ECPs keen on specialising in this area?

A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia

Compliance is key

Dispensing psychedelics safely

Managing patient enquiries

How does the nasal spray differ from EpiPen?

Can it be placed in a resuscitation kit?

Who is the nasal spray best suited to?

What should pharmacists know about its use?

Who is most likely to experience adverse effects?

Who might find it hard to use the nasal spray?

Could adrenaline nasal spray (neffy) be downscheduled?

How much does it cost?

Will the nasal spray be PBS listed?