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Techniques in Coloproctology Jun 2011Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been... (Review)
Review
Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty.
Topics: Anal Canal; Botulinum Toxins; Calcium Channel Blockers; Chronic Disease; Fissure in Ano; Humans; Nitroglycerin; Vasodilator Agents
PubMed: 21538013
DOI: 10.1007/s10151-011-0683-7 -
The Turkish Journal of Gastroenterology... Apr 2020An anal fissure (AF) is a linear tear in the distal anal canal and is one of the most common causes of anal pain. Hemorrhoidal disease (HD) is a symptomatic growth and...
BACKGROUND/AIMS
An anal fissure (AF) is a linear tear in the distal anal canal and is one of the most common causes of anal pain. Hemorrhoidal disease (HD) is a symptomatic growth and distal displacement of normal anal cushions. Numerous studies have addressed the contributing factors of these conditions, yet the results remain controversial. In this study, we hypothesize that increasing patients' awareness of hidden risk factors could reduce the rate of HD and AF.
MATERIALS AND METHODS
A questionnaire-based controlled study was planned. After power analysis, patients with HD (n=60) and AF (n=60) were enrolled consecutively into the study group and compared with the control group (n=60) of healthy individuals. The survey was designed to assess the participants' toilet and dietary habits and anxiety risk. Odds ratios were calculated and a binary logistic regression model was constructed to identify associated factors.
RESULTS
Hard stools, spending more than 5 minutes in the toilet, frequent straining during defecation, and increased spice intake were more frequent in the patients with HD; and hard fecal consistency, time elapsed in toilet greater than 5 min, straining during defecation, and high anxiety risk were more frequent in the patients with AF as compared to the control group (p<0.05).
CONCLUSION
Possible associations were identified between habitual factors or conditions (i.e., fecal consistency, the time elapsed in the toilet, straining during defecation) and anxiety and benign anorectal diseases (i.e., HD and AF). Patients should be advised about these hidden threats.
Topics: Adult; Anxiety; Case-Control Studies; Conservative Treatment; Cross-Sectional Studies; Defecation; Feeding Behavior; Female; Fissure in Ano; Hemorrhoids; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Patient Education as Topic; Surveys and Questionnaires
PubMed: 32412899
DOI: 10.5152/tjg.2020.19183 -
Cirugia Espanola Dec 2005Current treatment of chronic anal fissure continues to be based on conventional conservative measures in a high percentage of cases. What is known as chemical... (Review)
Review
Current treatment of chronic anal fissure continues to be based on conventional conservative measures in a high percentage of cases. What is known as chemical sphincterotomy aims to achieve a temporary decrease of anal pressures that allows fissures to heal. There are various alternatives such as nitroglycerine or diltiazem ointment and botulinum toxin injections. However, because of collateral effects and recurrences in the medium term, the definitive role of these treatments remains to be elucidated. Nevertheless, chemical sphincterotomy should be the first option in patients with a high risk of incontinence. "Open" or "closed" lateral internal sphincterotomy performed in the ambulatory setting with local anesthesia can currently be considered the ideal treatment of chronic anal fissure refractory to conservative measures so long as the patient is informed about the risk of minor incontinence. This procedure provides rapid and permanent recovery in more than 95% of patients. There is evidence demonstrating that the incontinence rate is related to the extent of the lateral internal sphincterotomy and consequently the extent of this procedure should be reduced to the length of the fissure.
Topics: Chronic Disease; Digestive System Surgical Procedures; Fissure in Ano; Humans
PubMed: 16478612
DOI: 10.1016/s0009-739x(05)74640-6 -
BMJ (Clinical Research Ed.) Aug 2003
Topics: Chronic Disease; Diagnosis, Differential; Fecal Incontinence; Fissure in Ano; Humans; Pain; Postoperative Complications; Risk Factors; Treatment Outcome
PubMed: 12919967
DOI: 10.1136/bmj.327.7411.354 -
Colorectal Disease : the Official... Nov 2008
Review
Topics: Clinical Protocols; Evidence-Based Medicine; Female; Fissure in Ano; Humans; Male
PubMed: 18954306
DOI: 10.1111/j.1463-1318.2008.01681.x -
Asian Journal of Surgery Jun 2021
Topics: Anal Canal; Chronic Disease; Fecal Incontinence; Fissure in Ano; Humans; Lateral Internal Sphincterotomy; Treatment Outcome
PubMed: 34053827
DOI: 10.1016/j.asjsur.2021.03.054 -
Nihon Rinsho. Japanese Journal of... Dec 1994
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Ryoikibetsu Shokogun Shirizu 1994
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Advances in Therapy 2006An anal fissure is a painful linear ulcer in the lower part of the anal canal. It is very often referred to as an ischemic ulcer. Anodermal blood flow is negatively... (Review)
Review
An anal fissure is a painful linear ulcer in the lower part of the anal canal. It is very often referred to as an ischemic ulcer. Anodermal blood flow is negatively correlated with resting pressure of the anus. Increased activity of the internal anal sphincter may decrease the anodermal blood supply by compressing arterioles. Surgical procedures and botulinum treatment for patients with chronic anal fissure produce a temporary reduction in anal pressure, reverse sphincter spasm, and promote fissure healing. However, recent studies have shown that fissure healing does not appear to be dependent on reduction in mean resting anal pressure. On the basis of the published literature, this article attempts to explain this phenomenon in detail. The mechanism of action of botulinum toxin on the internal anal sphincter is not yet fully understood. This review focuses on problems associated with anal fissure treatment and presents them from the wider angle of science about botulinum toxin. In our opinion, anodermal blood flow depends not only on the "mechanical" force of sphincters but also on biochemical processes that occur in the fissure region.
Topics: Botulinum Toxins, Type A; Chronic Disease; Fissure in Ano; Humans
PubMed: 17050505
DOI: 10.1007/BF02850051 -
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