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The Surgical Clinics of North America Jun 2024Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is... (Review)
Review
Hemorrhoids and anal fissures are two of the most common benign anorectal diseases. Despite their high prevalence, diagnostic accuracy of benign anorectal disease is suboptimal at 70% for surgeons, especially for hemorrhoidal diseases. Once the diagnosis is correctly made, numerous medical and surgical treatment options are available, each with different rates of success and complications. In this article, the authors review each step of patient management, with emphasis on evidence-based treatment options for hemorrhoids and anal fissures. The article discusses the pathophysiology, diagnosis, medical management, and procedures for hemorrhoids followed by a detailed overview on the management of anal fissures.
Topics: Hemorrhoids; Humans; Fissure in Ano; Hemorrhoidectomy
PubMed: 38677814
DOI: 10.1016/j.suc.2023.11.001 -
Current Opinion in Gastroenterology Jan 2020Anal fissures are very common. They are easy to diagnose and treat in the office setting. They may coexist with hemorrhoids. In fact 20% of patients with hemorrhoids... (Review)
Review
PURPOSE OF REVIEW
Anal fissures are very common. They are easy to diagnose and treat in the office setting. They may coexist with hemorrhoids. In fact 20% of patients with hemorrhoids have anal fissures also. The purpose of this review is to highlight current diagnosis and treatment of anal fissures using diet, ointments and botulinum toxin to enable healing. Medical treatment relies on reducing anal sphincter spasm to allow improved blood flow and healing.
RECENT FINDINGS
Many anorectal disorders can be managed in the office. Most anal fissures can be managed without the need for surgery. The need for anorectal examination, including use of anoscopy is stressed in the current literature. The use of calcium channel blockers in preference to nitroglycerin is highlighted as well as the use of botulinum toxin when ointments don't work.
SUMMARY
Anal fissure can be managed nonsurgically most of the time and gastroenterologists should be able to manage them. This article should help in preventing unnecessary surgery and its complications, mainly incontinence in a small but significant number. The search for more effective drugs and options for managing this disorder continues.
Topics: Anal Canal; Fissure in Ano; Gastroenterology; Humans; Wound Healing
PubMed: 31688336
DOI: 10.1097/MOG.0000000000000599 -
BMJ (Clinical Research Ed.) Jan 2022
Review
Topics: Adult; Chronic Disease; Fissure in Ano; Humans
PubMed: 35022226
DOI: 10.1136/bmj-2021-066834 -
Updates in Surgery Dec 2023The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice...
The best nonoperative or operative anal fissure (AF) treatment is not yet established, and several options have been proposed. Aim is to report the surgeons' practice for the AF treatment. Thirty-four multiple-choice questions were developed. Seven questions were about to participants' demographics and, 27 questions about their clinical practice. Based on the specialty (general surgeon and colorectal surgeon), obtained data were divided and compared between two groups. Five-hundred surgeons were included (321 general and 179 colorectal surgeons). For both groups, duration of symptoms for at least 6 weeks is the most important factor for AF diagnosis (30.6%). Type of AF (acute vs chronic) is the most important factor which guide the therapeutic plan (44.4%). The first treatment of choice for acute AF is ointment application for both groups (59.6%). For the treatment of chronic AF, this data is confirmed by colorectal surgeons (57%), but not by the general surgeons who prefer the lateral internal sphincterotomy (LIS) (31.8%) (p = 0.0001). Botulin toxin injection is most performed by colorectal surgeons (58.7%) in comparison to general surgeons (20.9%) (p = 0.0001). Anal flap is mostly performed by colorectal surgeons (37.4%) in comparison to general surgeons (28.3%) (p = 0.0001). Fissurectomy alone is statistically significantly most performed by general surgeons in comparison to colorectal surgeons (57.9% and 43.6%, respectively) (p = 0.0020). This analysis provides useful information about the clinical practice for the management of a debated topic such as AF treatment. Shared guidelines and consensus especially focused on operative management are required to standardize the treatment and to improve postoperative results.
Topics: Humans; Fissure in Ano; Botulinum Toxins, Type A; Neuromuscular Agents; Chronic Disease; Anal Canal; Surgeons; Colorectal Neoplasms; Treatment Outcome
PubMed: 37805973
DOI: 10.1007/s13304-023-01661-x -
CMAJ : Canadian Medical Association... Jul 2019
Review
Topics: Administration, Topical; Calcium Channel Blockers; Conservative Treatment; Fissure in Ano; Humans
PubMed: 31266788
DOI: 10.1503/cmaj.190074 -
Der Internist Oct 2017In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly... (Review)
Review
In proctology patients can often be helped with very little effort. With knowledge of the most common disease symptoms the treating physician can in many cases correctly recognize the cause of the complaints and initiate the appropriate therapy or arrange referral to a proctological institution. This article aims to briefly and succinctly present the most common diseases in proctology (e.g. mariscae, hemorrhoids, anal fissures, perianal venous thrombosis, abscesses and fistulas, condyloma acuminatum and anal carcinoma) and to provide the treating internist, even outside of gastroenterology, assistance with the management of proctological symptoms.
Topics: Abscess; Anal Canal; Anus Diseases; Condylomata Acuminata; Fissure in Ano; Hemorrhoids; Humans; Internal Medicine; Venous Thrombosis
PubMed: 28884323
DOI: 10.1007/s00108-017-0318-9 -
Mayo Clinic Proceedings Oct 2016Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this... (Review)
Review
Although pelvic pain is a symptom of several structural anorectal and pelvic disorders (eg, anal fissure, endometriosis, and pelvic inflammatory disease), this comprehensive review will focus on the 3 most common nonstructural, or functional, disorders associated with pelvic pain: functional anorectal pain (ie, levator ani syndrome, unspecified anorectal pain, and proctalgia fugax), interstitial cystitis/bladder pain syndrome, and chronic prostatitis/chronic pelvic pain syndrome. The first 2 conditions occur in both sexes, while the latter occurs only in men. They are defined by symptoms, supplemented with levator tenderness (levator ani syndrome) and bladder mucosal inflammation (interstitial cystitis). Although distinct, these conditions share several similarities, including associations with dysfunctional voiding or defecation, comorbid conditions (eg, fibromyalgia, depression), impaired quality of life, and increased health care utilization. Several factors, including pelvic floor muscle tension, peripheral inflammation, peripheral and central sensitization, and psychosocial factors, have been implicated in the pathogenesis. The management is tailored to symptoms, is partly supported by clinical trials, and includes multidisciplinary approaches such as lifestyle modifications and pharmacological, behavioral, and physical therapy. Opioids should be avoided, and surgical treatment has a limited role, primarily in refractory interstitial cystitis.
Topics: Algorithms; Anal Canal; Anus Diseases; Cystitis, Interstitial; Female; Humans; Male; Muscular Diseases; Pain; Pelvic Pain; Prostatitis
PubMed: 27712641
DOI: 10.1016/j.mayocp.2016.08.011 -
Current Treatment Options in... Dec 2018To overview the current medical literature on the efficacy of botulism toxin treatment (BTX-A) for lower gastrointestinal disorders (GIT). (Review)
Review
PURPOSE OF REVIEW
To overview the current medical literature on the efficacy of botulism toxin treatment (BTX-A) for lower gastrointestinal disorders (GIT).
RECENT FINDINGS
BTX-A was found to have a short-term efficacy for the treatment of dyssynergic defecation. Surgical treatment was found to be more effective than BTX-A for the healing of chronic anal fissures, and BTX-A can be considered when surgery is undesirable. Data regarding the effects of BTX-A injection for the treatment of chronic anal pain is limited. Beneficial effects were observed only in a minority of patients. BTX-A treatment was found to be effective for the treatment of obstructive symptoms after surgery for Hirsprung's disease as well as for the treatment of internal anal sphincter achalasia. BTX-A treatment has a short-term efficacy and is safe. Further research is still needed in order to establish the exact place of BTX-A treatment of lower GIT disorders.
PubMed: 30397849
DOI: 10.1007/s11938-018-0205-z -
Clinics in Colon and Rectal Surgery Mar 2018Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when... (Review)
Review
Anorectal complaints are not uncommon in pediatric care, but the etiology and management can differ significantly from adults. Age is an important factor when considering etiology and management, distinguishing between infants, children, and adolescents. For all ages, malignancy is rarely a consideration, but a thorough examination of infants and children typically requires deep sedation or general anesthesia. Very little primary literature or evidence exists to guide care; so there are many opportunities for careful study to enhance our understanding beyond personal experience and historical practice patterns.
PubMed: 29487494
DOI: 10.1055/s-0037-1609026 -
La Revue Du Praticien Mar 2023MANAGEMENT OF ANAL FISSURE. The news in the management of the anal fissure are few but to know. The medical treatment must be well explained to the patient and optimized...
MANAGEMENT OF ANAL FISSURE. The news in the management of the anal fissure are few but to know. The medical treatment must be well explained to the patient and optimized from the outset. Healthy bowel movements combining a sufficient fiber intake and soft laxatives must be continued for at least 6 months. Pain control is important. Topicals, specific (in case of sphincter hypertonia) or not, must be maintained for 6 to 8 weeks. Calcium channel blockers seem the most interesting with fewer side effects for similar effectiveness. Surgery is proposed (apart a no medically control of the pain or a fistula associated) in the event of failure of well-conducted medical treatment. It remains the most effective long-term treatment. Lateral internal sphincterotomy has its place in the absence of anal continence disorder, in which case fissurectomy and/or cutaneous anoplasty can be proposed.
Topics: Humans; Fissure in Ano; Treatment Outcome; Defecation; Digestive System Surgical Procedures; Pain; Chronic Disease
PubMed: 37289116
DOI: No ID Found