Materiały źródłowe

• #1 Anal fissure: Medical management – UpToDate

  https://www.uptodate.com/contents/anal-fissure-medical-management

  Anal fissure is one of the most common benign anorectal conditions. Trauma to the anoderm with the passage of a hard stool is thought to be a common initiating factor. Persistence of a fissure is typically associated with anal spasm or high anal pressure. The treatment of anal fissure breaks the cyclic anal sphincter spasm, prevents tearing of the anal mucosa, and promotes healing of the fissure. […] The majority of anal fissures are treated medically, which is the topic of this discussion. Surgical therapy, which is reserved for refractory anal fissures, is discussed in another topic. […] For patients with a typical anal fissure (ie, a single posterior or anterior fissure with no evidence of Crohn disease), we recommend prescribing a combination of supportive measures (fiber, sitz bath, topical analgesic) and one of the topical vasodilators (nifedipine or nitroglycerin) for one month. In addition, patients who are constipated should receive a stool softener or laxative. The treatment goal is to relax the internal anal sphincter, initiate and maintain atraumatic passage of stool, and relieve pain.

• #2

  https://www.nhs.uk/conditions/anal-fissure/

  A GP can prescribe medicine to help relieve your symptoms and speed up the healing process. […] Surgery may be recommended in persistent cases of anal fissure where self-help measures and medicine have not helped. […] Surgery is often very effective at treating anal fissures, but it does carry a small risk of complications, such as temporary or permanent loss of bowel control (bowel incontinence). […] Anal fissures usually heal within a few weeks without the need for treatment. […] But they can easily come back if they’re caused by constipation that remains untreated. […] In some people, symptoms from anal fissures last 6 weeks or more (chronic anal fissures).

• #3 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  Anal fissures typically cause pain and bleeding with bowel movements. […] Most anal fissures get better with simple treatments, such as eating more fiber or soaking in a warm-water bath. Some people with anal fissures may need medicine. Sometimes, surgery may be necessary. […] You may be able to prevent an anal fissure by taking measures to prevent constipation or diarrhea. Eat high-fiber foods, drink fluids, and exercise regularly to keep from having to strain during bowel movements. […] An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment. […] An unhealed fissure may trigger a cycle of discomfort that may require medicines or surgery to ease the pain and to repair or remove the fissure.

• #4 Anal Fissures | Conditions | UCSF Health

  https://www.ucsfhealth.org/education/anal-fissures

  The goal of treatment is to alleviate pain and control spasms so that the tear in the skin can heal. The choice of treatment depends on whether the fissure is acute or chronic. […] Most acute anal fissures will heal on their own within four to six weeks. You can help the process along with the following self-care measures: […] When a fissure is chronic, the first line of treatment is usually one of the following topical medications: […] If your fissure persists or your symptoms are severe, your doctor may suggest one of two procedures to relax the muscles in the anal sphincter. Both are highly effective. The options are: […] Both treatments are done on an outpatient basis (no hospital stay required). […] You and your doctor can discuss the risks of each and determine your best option.

• #5 Anal Fissures – Children’s Hospital of Orange County

  https://choc.org/programs-services/gastroenterology/constipation/anal-fissures/

  Anal fissures are tears or cracks in the anus. Fissures result from stretching the anal mucosa beyond its normal capacity. Once the tear occurs, it leads to repeated injury. The exposed internal sphincter muscle beneath the tear goes into spasm. This causes severe pain. The spasm also pulls the edges of the fissure apart, making it difficult for the wound to heal. The spasm then leads to further tearing of the mucosa during bowel movements. This cycle leads to the development of a chronic anal fissure in approximately 40 percent of patients. […] An acute anal fissure typically heals within six weeks with conservative treatment. Some disappear when constipation is treated. Anal fissures that last for six weeks or more are called chronic anal fissures. These fail conservative treatment and require a more aggressive, surgical approach.

• #6 Anal fissure – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/anal-fissure.html

  An anal fissure is a common, mostly benign, condition that can be acute or chronic. […] The management of primary anal fissures is generally non-operative and includes increased dietary fibre, sitz baths, topical ointments and botulinum toxin injections. If these treatments are ineffective the patient will need a surgical referral. […] An acute anal fissure commonly heals with 48 weeks of conservative therapy. If this therapy fails and the fissure becomes chronic, surgery is usually required. […] Almost 50% of patients with acute anal fissures will heal with conservative measures alone involving only increased fibre intake (e.g. psyllium) and warm bathing of the perineum (sitz baths). […] First-line therapy often includes the conservative measures plus a topical drug. The preparations used in clinical practice contain glyceryl trinitrate or a calcium channel blocker.

• #7 Treatment Algorithm for Anal Fissure. Consensus Document of the Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons | Cirugía Española (English Edition)

  https://www.elsevier.es/en-revista-cirugia-espanola-english-edition–436-articulo-treatment-algorithm-for-anal-fissure–S2173507718301017

  The Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons propose this consensus document with a treatment algorithm for anal fissure that could be used for decision making. Non-surgical therapy and surgical treatment of anal fissure are explained, and the recommended algorithm is provided. […] The conservative treatment of AF is contemplated as an initial therapeutic step, both in the acute and chronic phases of this process. […] Treatment aims to reduce anal muscle tone as an initial measure. […] These conservative measures by themselves can cure AF and prevent recurrences. […] Medical or pharmacological treatment should be aimed at achieving transitory relaxation of the internal anal sphincter, thereby resolving hypertonia and improving the vascularization of the mucosa of this area, but with the subsequent recovery of the normal baseline tone, thereby avoiding the risk of incontinence.

• #8 Anal fissure – symptoms, causes, and treatments | healthdirect

  https://www.healthdirect.gov.au/anal-fissure

  An anal fissure is a small tear or split in the skin that lines the anus. […] There are different treatment options for anal fissures. […] Most anal fissures will heal on their own. Conservative treatment aims to: reduce constipation, relieve the pain, heal the fissure. […] It involves eating lots of high-fibre foods and drinking lots of water to soften your stools (poos). Conservative treatment usually works in 6 to 8 weeks. […] Your doctor may also recommend: a stool softener, warm baths or sitz baths. […] If GTN doesn’t work, your doctor may prescribe a medicine called calcium channel blockers. […] Botox is another treatment option. It’s a chemical that’s injected into the muscles around your anus to help them relax. […] Your doctor may recommend surgery if other treatments have not been helpful. […] Anal fissure surgery is known as a lateral internal sphincterotomy. A small cut is made in your sphincter muscle, which relieves tension.

• #9

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

  NONSURGICAL TREATMENT Your physician will discuss the benefits and side effects of treatments. Treatment includes: A high-fiber diet and over-the-counter fiber supplements (25-35 grams of fiber/day) to make stools soft, formed, and bulky. Over-the-counter stool softeners to make stools easier to pass. Drinking more water to help prevent hard stools and aid in healing. Warm tub baths (sitz baths) for 10 to 20 minutes, a few times per day (especially after bowel movements to soothe the area and help relax anal sphincter muscles). This is thought to help the healing process. Medications, such as lidocaine, that can be applied to the skin around the anus for pain relief. Medications such as diltiazam, nifedipine, or nitroglycerin ointment to relax the anal sphincter muscles which helps the healing process.

• #10 Anal Fissure – Little Wound, Major Pain | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/bangkok/content/anal-fissure

  Anal fissure is a common condition which should not be neglected. If left untreated, it may cause a complication of anal fistula or concerns about a lump which may become malignant. So, if you suspect that you have an anal fissure, you should consult a specialist to diagnose and treat correctly. The treatments can be divided into surgical and non-surgical treatments. […] Non-surgical Treatment is suitable for patients with an early stage of anal fissure: Drink 6-8 glasses of water, Consume more fruits and vegetables, Take laxatives to relief constipation, make stool softer, and reduce inflammation and pain, Soak in warm water for 15 minutes 2-3 times a day to reduce pain and increase blood flow, Use topical medication to relax the sphincter and increase blood flow, Inject Botulinum Toxin to relax sphincter muscle and increase blood flow.

• #11 Patient education: Anal fissure (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anal-fissure-beyond-the-basics/print

  Anal fissure treatment involves medical and surgical approaches aimed at reducing the tone of the internal sphincter muscle, leading to pain relief and healing of the anal fissure. […] Initial treatment is medical and aimed at eliminating constipation, softening stools, and reducing anal sphincter spasm. […] These measures are successful in 60 to 90 percent of patients. However, some patients may not heal, or they may develop frequent recurrences. Such patients may require surgery, which is successful more than 95 percent of the time. […] Fiber therapy — Avoiding hard bowel movements will prevent trauma to the anal canal, promoting healing of the fissure. Increasing fiber in the diet is one of the best ways to soften and bulk the stool. […] Topical nifedipine and topical nitroglycerin — Topical nifedipine works by reducing the internal anal sphincter pressure.

• #12 Anal Fissure Treatment for FASTER HEALING & PAIN RELIEF with Bowel Movements – Pelvic Exercises

  https://www.pelvicexercises.com.au/anal-fissure-treatment/?srsltid=AfmBOoqzICRwBXoE9bqXFm4chaQNZ3KA87fnLgK5m2XrYCL7hRT4LdCj

  Anal fissure treatment for anal fissure healing and relieving anal pain with bowel movements presented by Pelvic Floor Physiotherapist Michelle Kenway. […] Using the correct bowel emptying position and technique is an important aspect of anal fissure treatment. […] Its important to avoid straining or pushing down through the anus during bowel emptying to minimise stretching the anal tissues and fissure. […] Anal fissure healing is promoted by having a soft, smooth well formed stool. […] Stool softeners are mild laxatives are that usually available over the counter from the pharmacy. […] Diet for anal fissure treatment aims to achieve a soft well-formed stool that is not bulky and avoids constipation. […] Choose foods with high soluble (dissolvable) fibre content. This type of fiber will avoid bulking the stool and soften the stool to help promote anal fissure healing.

• #13 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Treatment.aspx

  Most cases of anal fissure heal spontaneously within a few weeks, without requiring treatment. However, some individuals may be affected by a chronic anal fissure that continues to plague them for six weeks or more. […] There are several self-care techniques that can help to increase the ease of passing stools. These assist skin healing following the occurrence of an anal fissure. This helps the skin in the area to develop strength and prevent the recurrence of anal fissures. […] Self-care tips to improve recovery for individuals with, or recovering from, an anal fissure, include: Increasing the intake of dietary fiber by consuming more fruit, vegetables and whole grains, with fiber supplements if necessary; Staying hydrated by drinking sufficient water; Having a bowel movement without delay when the urge presents; Exercising regularly for at least 30 minutes each day; Avoiding products containing fragrance or alcohol that will come into contact with the anus; Avoiding medications which cause constipation; Use a mild laxative regularly for a few weeks to allow the fissure to heal.

• #14

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  The majority of anal fissures do not require surgery. The most common treatment for an acute anal fissure consists of making ones stool more consistent with a diet high in fiber as well as utilizing over-the-counter fiber supplementation (totaling 25-35 grams of fiber/day). Stool softeners and increasing water intake may be necessary to promote soft bowel movements and aid in the healing process. Antidiarrheals may be needed for loose, frequent stools. Topical anesthetics, such as lidocaine, can be used for anal pain and warm tub baths (sitz baths) for 10-20 minutes several times a day (especially after bowel movements) are soothing and promote relaxation of the anal muscles, helping the healing process. […] Other medications may be prescribed, when a patient has a more chronic-type fissure, that promote relaxation of the anal sphincter muscles. Your surgeon will go over benefits and side-effects of each of these with you. Chronic fissures are generally more difficult to treat, and your surgeon may advise surgical treatment either as an initial treatment or following attempts at medical management.

• #15 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  Anal fissures often heal within a few weeks with appropriate home treatment. Take steps to keep the stool soft, such as increasing your intake of fiber and fluids. Soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can help relax the sphincter and promote healing. If symptoms persist, you’ll likely need further treatment. […] A healthcare professional may recommend the following: […] Externally applied nitroglycerin (Rectiv) can help increase blood flow to the fissure and promote healing. It also can help relax the anal sphincter. Nitroglycerin is generally considered the treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. […] Topical anesthetic creams such as lidocaine (Xylocaine) may help relieve pain.

• #16 Anal Fissure – Little Wound, Major Pain | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/bangkok/content/anal-fissure

  Anal fissure is a common condition which should not be neglected. If left untreated, it may cause a complication of anal fistula or concerns about a lump which may become malignant. So, if you suspect that you have an anal fissure, you should consult a specialist to diagnose and treat correctly. The treatments can be divided into surgical and non-surgical treatments. […] Non-surgical Treatment is suitable for patients with an early stage of anal fissure: Drink 6-8 glasses of water, Consume more fruits and vegetables, Take laxatives to relief constipation, make stool softer, and reduce inflammation and pain, Soak in warm water for 15 minutes 2-3 times a day to reduce pain and increase blood flow, Use topical medication to relax the sphincter and increase blood flow, Inject Botulinum Toxin to relax sphincter muscle and increase blood flow.

• #17 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Topical steroids may be recommended to ease swelling if it is severe. This may help to relieve pain and any itching. Steroids should not be used for more than one week at a time to avoid side effects, such as skin thinning or enlarged blood vessels. […] An anal fissure will heal more easily if feces is kept soft, so that it can pass more easily. A diet involving plenty of high-fiber foods may help, such as fruit, vegetables, whole grains, nuts and seeds. […] Other general measures that are recommended alongside medicine for anal fissure may include: Washing the area carefully with water after using the toilet, to avoid irritation and infection. Soap should be avoided as this may cause irritation, and the area should be gently dried. […] Sitz baths for anal fissure may be recommended as they are thought to soothe and relax the anus muscles, relieving some of the painful internal sphincter muscle spasm. This involves sitting in plain, non-soapy water after defecation.

• #18 Anal Fissure: Treatment, Symptoms, Causes, Healing, and More

  https://www.healthline.com/health/anal-fissure

  Treating an anal fissure typically involves practices that help the area heal, like using a sitz bath or taking stool softeners. Other times a doctor may recommend medication or a medical procedure. […] Certain treatments can promote healing and help relieve discomfort, including stool softeners and topical pain relievers. […] If an anal fissure doesn’t improve with these treatments, you may need surgery. Or your doctor may need to look for other underlying disorders that can cause anal fissures. […] Most anal fissures don’t require extensive treatment. However, certain home remedies can help promote healing and relieve uncomfortable symptoms. You can treat an anal fissure at home by: using over-the-counter stool softeners, drinking more fluids to stay hydrated and improve digestion, taking fiber supplements and eating more fibrous foods, taking a sitz bath to relax the anal muscles, relieve irritation, and increase blood flow to the anorectal area, applying nitroglycerin ointment to promote blood flow to the area or hydrocortisone cream, such as Cortizone 10, applying topical pain relievers, such as lidocaine, to the anus to ease discomfort.

• #19 Anal Fissure – Little Wound, Major Pain | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/bangkok/content/anal-fissure

  Anal fissure is a common condition which should not be neglected. If left untreated, it may cause a complication of anal fistula or concerns about a lump which may become malignant. So, if you suspect that you have an anal fissure, you should consult a specialist to diagnose and treat correctly. The treatments can be divided into surgical and non-surgical treatments. […] Non-surgical Treatment is suitable for patients with an early stage of anal fissure: Drink 6-8 glasses of water, Consume more fruits and vegetables, Take laxatives to relief constipation, make stool softer, and reduce inflammation and pain, Soak in warm water for 15 minutes 2-3 times a day to reduce pain and increase blood flow, Use topical medication to relax the sphincter and increase blood flow, Inject Botulinum Toxin to relax sphincter muscle and increase blood flow.

• #20 Information and Treatment for Anal Fissure | Brown University Health

  https://www.brownhealth.org/centers-services/pelvic-floor-disorders-program/pelvic-floor-disorders/information-and-treatment

  To avoid an anal fissure caused by constipation, keep your bowels regular and stools soft by getting plenty of fiber in your diet or taking supplementary fiber, and drinking plenty of water, six to eight 10-ounce glasses a day. […] You can soothe the pain of an anal fissure with acetaminophen or ibuprofen, use topical anesthetics that contain lidocaine, and take sitz baths (sit in warm water for 10 to 20 minutes) several times a day. The soaks promote relaxation of the anal muscles, which may hasten healing. […] Anal fissures usually heal within a few weeks without the need for treatment. Your health care professional may recommend applying medicated ointment, taking soothing sitz baths (sitting in warm water), and taking over-the-counter analgesics. Narcotic pain medications are not recommended, as they promote constipation. […] If surgery is necessary, it is curative in 90 percent of chronic anal fissures.

• #21 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  A chronic anal fissure is a common perianal condition. This review aims to evaluate both existing and new therapies in the treatment of chronic fissures. Pharmacological therapies such as glyceryl trinitrate (GTN), Diltiazem ointment and Botulinum toxin provide a relatively non-invasive option, but with higher recurrence rates. Lateral sphincterotomy remains the gold standard for treatment. […] New therapies include perineal support devices, Gonyautoxin injection, fissurectomy, fissurotomy, sphincterolysis, and flap procedures. Further research is required comparing these new therapies with existing established therapies. This paper recommends initial pharmacological therapy with GTN or Diltiazem ointment with Botulinum toxin as a possible second line pharmacological therapy. Perineal support may offer a new dimension in improving healing rates. Lateral sphincterotomy should be offered if pharmacological therapy fails. New therapies are not suitable as first line treatments, though they can be considered if conventional treatment fails.

• #22 Anal Fissure | Section of Colon and Rectal Surgery | Washington University in St. Louis

  https://colorectalsurgery.wustl.edu/patient-care/cope-center/anorectal-disorders/anal-fissure/

  Lidocaine 2% jelly Lidocaine is a topical anesthetic that will numb the anal fissure, reducing symptoms. Lidocaine can be applied two to three times a day as needed. […] Nifedipine 0.2% ointment Nifedipine may be prescribed for chronic fissures to decrease anal sphincter spasm; it improves blood flow to the area, healing the fissure. It is applied twice daily and takes at least 4 to 6 weeks to be effective. […] Botox Outpatient surgery treatment for patients in whom a lateral internal sphincterotomy may be risky. […] Sphincterotomy A same-day surgical procedure to divide the portion of internal sphincter that is in spasm. This is performed after all nonoperative measures fail.

• #23 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  Most do. These are acute anal fissures (temporary). They might not need any treatment at all, beyond self-care. Or you might only need a prescription cream for temporary pain relief, like lidocaine. But if your fissure hasn’t healed after several weeks, it needs treatment. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues. […] Medications for anal fissures include: Nitroglycerin ointment. Nitroglycerin is a vasodilator, a medicine that makes your blood vessels expand. Applied as a cream, it can restore blood flow and can help your anal sphincter relax. However, it can cause headaches, and some people have to discontinue it for this reason.

• #24 Anal Fissure: Symptoms, Causes & List of Treatments | Ada

  https://ada.com/conditions/anal-fissure/

  Anal fissure treatment generally involves softening the stool, avoiding constipation where possible and practicing good hygiene. Anal fissures typically heal within six weeks. An anal fissure that lasts for more than six weeks is called a chronic anal fissure. Occasionally, surgery is required to repair the tear. […] Treatment of an anal fissure primarily aims to ease the pain. Anal fissure treatment generally begins with following a high-fiber diet, as well as maintaining sufficient fluid intake to soften feces and prevent further damage to the area while the wound is healing. Pain medication will usually also be prescribed. […] Usually, an anal fissure will heal with home treatment. In the case of chronic anal fissure, however, occasionally surgery will be recommended. […] Anal fissure pain relief and other medicines may include: Anesthetic cream or ointment. This should be applied before going to the toilet. Anesthetic creams and ointments can be obtained by prescription or over the counter. Anesthetic ointments should only be used for short periods of up to about five to seven days, otherwise the skin around the anus may become irritated.

• #25 Anal fissure: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001130.htm

  Most fissures heal on their own and do not need treatment. […] To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently. […] Worrying about pain during a bowel movement may cause a person to avoid them. But not having bowel movements will only cause the stools to become even harder, which can make the anal fissure worse. […] Prevent hard stools and constipation by: Making dietary changes — eating more fiber or bulk, such as fruits, vegetables, and grains; Drinking more fluids; Using stool softeners. […] Ask your provider about the following ointments or creams to help soothe the affected skin: Numbing cream, if pain interferes with normal bowel movements; Petroleum jelly; Zinc oxide, 1% hydrocortisone cream, Preparation H, and other products.

• #26 Anal fissure – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/anal-fissure.html

  An anal fissure is a common, mostly benign, condition that can be acute or chronic. […] The management of primary anal fissures is generally non-operative and includes increased dietary fibre, sitz baths, topical ointments and botulinum toxin injections. If these treatments are ineffective the patient will need a surgical referral. […] An acute anal fissure commonly heals with 48 weeks of conservative therapy. If this therapy fails and the fissure becomes chronic, surgery is usually required. […] Almost 50% of patients with acute anal fissures will heal with conservative measures alone involving only increased fibre intake (e.g. psyllium) and warm bathing of the perineum (sitz baths). […] First-line therapy often includes the conservative measures plus a topical drug. The preparations used in clinical practice contain glyceryl trinitrate or a calcium channel blocker.

• #27 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  Most do. These are acute anal fissures (temporary). They might not need any treatment at all, beyond self-care. Or you might only need a prescription cream for temporary pain relief, like lidocaine. But if your fissure hasn’t healed after several weeks, it needs treatment. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues. […] Medications for anal fissures include: Nitroglycerin ointment. Nitroglycerin is a vasodilator, a medicine that makes your blood vessels expand. Applied as a cream, it can restore blood flow and can help your anal sphincter relax. However, it can cause headaches, and some people have to discontinue it for this reason.

• #28 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  Anal fissures often heal within a few weeks with appropriate home treatment. Take steps to keep the stool soft, such as increasing your intake of fiber and fluids. Soak in warm water for 10 to 20 minutes several times a day, especially after bowel movements. This can help relax the sphincter and promote healing. If symptoms persist, you’ll likely need further treatment. […] A healthcare professional may recommend the following: […] Externally applied nitroglycerin (Rectiv) can help increase blood flow to the fissure and promote healing. It also can help relax the anal sphincter. Nitroglycerin is generally considered the treatment of choice when other conservative measures fail. Side effects may include headache, which can be severe. […] Topical anesthetic creams such as lidocaine (Xylocaine) may help relieve pain.

• #29 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  The principle aim of treatment for chronic anal fissures is to decrease internal sphincter tone and hence increase the blood flow with subsequent tissue healing. Treatment options include pharmacological and surgical means. […] Conventional surgical therapy involves finger anal dilatation and lateral internal sphincterotomy. Finger anal dilatation is generally regarded by many colorectal surgeons to be an obsolete method as finger dilatation has been associated with the development of anal incontinence. Lateral sphincterotomy has been regarded as the gold standard for treatment of chronic fissures. […] In evaluating the results of the various modalities of treatment, the healing, recurrence and incontinence rates are of key interest. […] The healing rates for topical GTN ointment range from 40.4% to 68%. The most common concentration tested was 0.2% GTN ointment, which is the usual dose used in treatment. The majority of the patients healed within 2 mo. However, recurrences do occur at a rate of 7.9% to 50%. […] The healing rates for topical Diltiazem ointment range from 67% to 89.4%. The concentration tested was 2% Diltiazem ointment. […] The healing rates for Botulinum toxin injection range from 27% to 96%. The dosages used ranged from 20 to 25 units. The majority of the cases also healed within 2 mo, similar to rates for GTN ointment.

• #30 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  Most do. These are acute anal fissures (temporary). They might not need any treatment at all, beyond self-care. Or you might only need a prescription cream for temporary pain relief, like lidocaine. But if your fissure hasn’t healed after several weeks, it needs treatment. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues. […] Medications for anal fissures include: Nitroglycerin ointment. Nitroglycerin is a vasodilator, a medicine that makes your blood vessels expand. Applied as a cream, it can restore blood flow and can help your anal sphincter relax. However, it can cause headaches, and some people have to discontinue it for this reason.

• #31 Anal Fissure: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/anal-fissure-pro

  Most anal fissures respond well to conservative or topical management. In refractory cases surgery may be required. […] The management of primary anal fissures is generally non-operative and includes increased dietary fibre, warm baths, topical ointments and botulinum toxin injections. If these treatments are ineffective then surgical intervention may be considered. Secondary anal fissures require further investigation. […] Options in primary care include: Simple oral analgesia. Paracetamol or ibuprofen as required. Warm baths. Consider prescribing glyceryl trinitrate (GTN) ointment: For adults who have had a fissure for over a week without improvement. (Use for children advised in secondary care only.) Apply twice a day for up to eight weeks. GTN relaxes smooth muscle, thus reducing anal tone.

• #32 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  OnabotulinumtoxinA (Botox) injection paralyzes the anal sphincter muscle and relaxes spasms. […] Blood pressure medicines, such as nifedipine or diltiazem, help relax the anal sphincter. These medicines are generally applied to the skin but also can be taken by mouth. However, when taken by mouth, their side effects can be greater. These medicines may be used when nitroglycerin is not effective or causes serious side effects. […] If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, surgery may be recommended. Surgeons usually perform a procedure called lateral internal sphincterotomy (LIS). LIS involves cutting a small part of the anal sphincter muscle. This technique may help promote healing and reduce spasm and pain. […] Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, surgery has a small risk of causing incontinence.

• #33 Anal fissures: An update on treatment options

  https://www1.racgp.org.au/ajgp/2024/january-february/anal-fissures

  Glyceryl nitrate (GTN) ointment is often used for acute AF treatment. […] Topical calcium channel blockers (CCBs) relax the IAS by blocking calcium influx to the cytoplasm of smooth muscle cells. […] Botulinum toxin A (BTA) is produced by Clostridium botulinum and acts as an inhibitory neurotransmitter by preventing acetylcholine release from presynaptic terminals. […] Surgical management of AF is typically recommended at least 68 weeks after attempting conservative treatment, although it might be the first-line treatment if the fissure is hyperalgesic or infected. […] Lateral internal sphincterotomy (LIS) is most often used for managing chronic AF. […] Fissurectomy consists of resecting the fibrous edges of the fissure, the sentinel skin tag and the hypertrophied anal papilla. […] Chronic AF should be treated with a combination of medical and surgical management.

• #34 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  The principle aim of treatment for chronic anal fissures is to decrease internal sphincter tone and hence increase the blood flow with subsequent tissue healing. Treatment options include pharmacological and surgical means. […] Conventional surgical therapy involves finger anal dilatation and lateral internal sphincterotomy. Finger anal dilatation is generally regarded by many colorectal surgeons to be an obsolete method as finger dilatation has been associated with the development of anal incontinence. Lateral sphincterotomy has been regarded as the gold standard for treatment of chronic fissures. […] In evaluating the results of the various modalities of treatment, the healing, recurrence and incontinence rates are of key interest. […] The healing rates for topical GTN ointment range from 40.4% to 68%. The most common concentration tested was 0.2% GTN ointment, which is the usual dose used in treatment. The majority of the patients healed within 2 mo. However, recurrences do occur at a rate of 7.9% to 50%. […] The healing rates for topical Diltiazem ointment range from 67% to 89.4%. The concentration tested was 2% Diltiazem ointment. […] The healing rates for Botulinum toxin injection range from 27% to 96%. The dosages used ranged from 20 to 25 units. The majority of the cases also healed within 2 mo, similar to rates for GTN ointment.

• #35 Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes

  https://coloproctol.org/DOIx.php?id=10.3393/ac.2014.30.3.132

  Topical diltiazem 2% ointment was used as it appears to be at least equally efficacious as GTN but with fewer side-effects. […] Failure of treatment with topical diltiazem resulted in a fissurectomy and Botox injection. […] A second cycle of topical cream or a fissurectomy Botox injection can sometimes avoid a subsequent sphincterotomy. […] In conclusion, conservative therapy for a chronic anal fissure includes medical and surgical techniques. A stepwise approach to treatment that incorporates medical and surgical treatments is time consuming and requires patient counseling, but ultimately such an approach can successfully preserve the integrity of the anal sphincter muscle for the majority of patients. Recurrences are common, so long-term follow-ups of patients who underwent conservative therapies are required to fully assess the efficacy of treatment.

• #36 Anal fissure – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/diagnosis-treatment/drc-20351430

  OnabotulinumtoxinA (Botox) injection paralyzes the anal sphincter muscle and relaxes spasms. […] Blood pressure medicines, such as nifedipine or diltiazem, help relax the anal sphincter. These medicines are generally applied to the skin but also can be taken by mouth. However, when taken by mouth, their side effects can be greater. These medicines may be used when nitroglycerin is not effective or causes serious side effects. […] If you have a chronic anal fissure that is resistant to other treatments, or if your symptoms are severe, surgery may be recommended. Surgeons usually perform a procedure called lateral internal sphincterotomy (LIS). LIS involves cutting a small part of the anal sphincter muscle. This technique may help promote healing and reduce spasm and pain. […] Studies show that surgery is much more effective than any medical treatment for chronic fissure. However, surgery has a small risk of causing incontinence.

• #37 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Botulinum toxin (eg, onabotulinumtoxinA) has been used to treat acute and chronic anal fissures. It is injected directly into the internal anal sphincter, in effect performing a chemical sphincterotomy. […] Surgical therapy is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures. […] Lateral internal sphincterotomy is the current surgical procedure of choice for anal fissure. The purpose of the operation is to cut the hypertrophied internal sphincter, thereby releasing tension and allowing the fissure to heal. […] When treating a chronic anal fissure, the surgeon may elect to perform a fissurectomy in conjunction with the lateral sphincterotomy. […] Sphincterotomy is performed either in an outpatient setting or as an office procedure, and patients return home the same day.

• #38 Patient education: Anal fissure (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anal-fissure-beyond-the-basics/print

  Nitroglycerin also results in a reduction in pressure of the internal anal sphincter, which decreases pain and further facilitates healing. […] Botulinum toxin — Botulinum toxin is a neurotoxin produced by a bacterium, Clostridium botulinum. It temporarily paralyzes muscles for up to three months, and it can be injected into the internal anal sphincter muscle in a clinician’s office without anesthesia or sedation. […] Surgery — Surgical procedures are generally reserved for people with symptoms that have persisted despite medical therapy for at least one to three months. The procedure of choice is called a lateral internal sphincterotomy, which relaxes the internal anal sphincter by cutting this muscle. […] Comparison among surgery and nitroglycerin, botulinum toxin, and nifedipine or diltiazem reveals that surgery has a higher success rate.

• #39 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  The principle aim of treatment for chronic anal fissures is to decrease internal sphincter tone and hence increase the blood flow with subsequent tissue healing. Treatment options include pharmacological and surgical means. […] Conventional surgical therapy involves finger anal dilatation and lateral internal sphincterotomy. Finger anal dilatation is generally regarded by many colorectal surgeons to be an obsolete method as finger dilatation has been associated with the development of anal incontinence. Lateral sphincterotomy has been regarded as the gold standard for treatment of chronic fissures. […] In evaluating the results of the various modalities of treatment, the healing, recurrence and incontinence rates are of key interest. […] The healing rates for topical GTN ointment range from 40.4% to 68%. The most common concentration tested was 0.2% GTN ointment, which is the usual dose used in treatment. The majority of the patients healed within 2 mo. However, recurrences do occur at a rate of 7.9% to 50%. […] The healing rates for topical Diltiazem ointment range from 67% to 89.4%. The concentration tested was 2% Diltiazem ointment. […] The healing rates for Botulinum toxin injection range from 27% to 96%. The dosages used ranged from 20 to 25 units. The majority of the cases also healed within 2 mo, similar to rates for GTN ointment.

• #40 What is a chronic anal fissure? | Information for the public | Chronic anal fissure: 2% topical diltiazem hydrochloride | Advice | NICE

  https://www.nice.org.uk/advice/esuom3/ifp/chapter/what-is-a-chronic-anal-fissure

  If the person has had to stop treatment with GTN, or the fissure hasn’t healed or has come back, other treatments can be tried. These include botulinum toxin injections (such as Botox or other brands) into the area around the anus (back passage) or a surgical procedure called spincterotomy. Both these treatments help the ring muscle (sphincter) to relax and allow more blood to flow to the lining of the anus (back passage). Diltiazem hydrochloride cream or ointment can also be tried. It is also sometimes used in children; there is no licensed medicine for treating chronic anal fissures in children.

• #41 Management of Anal Fissures: Guidelines From the American Society of Colon and Rectal Surgeons | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0200/practice-guidelines-anal-fissures.html

  Conservative therapy with bulking supplements and sitz baths leads to resolution of acute anal fissures in approximately one-half of patients. […] Although topical calcium channel blockers and nitroglycerin lead to resolution of approximately one-half of chronic anal fissures, topical calcium channel blockers have fewer adverse effects, such as headache. […] Botulinum toxin injections are as effective as topical therapies but can lead to transient fecal incontinence in 5% of treated patients. […] The American Society of Colon and Rectal Surgeons has released guidelines for the treatment of anal fissures.

• #42 How to cure fissures permanently without surgery

  https://www.medicalnewstoday.com/articles/how-to-cure-fissures-permanently-without-surgery

  Topical nitrates, for example, nitroglycerine, will help relax the muscles around the anus and increase blood flow to the fissure to promote healing. Healing may take 6-8 weeks but may require 12 weeks. […] Calcium channel blockers, such as diltiazem and nifedipine, can also help relax the anal sphincter. Medical professionals may prescribe this drug in a topical form that they can apply to the skin, but they may also prescribe oral medications. A 2020 study found that these drugs are more effective in treating anal fissures than topical anesthetics alone. […] A botulinum toxin (Botox) injection paralyzes the internal anal sphincter for about 3-4 months, which should be enough for the fissure to heal completely. It has a 60-80% healing rate. However, people treated with a Botox injection tend to recur up to 42% of the time.

• #43 Patient education: Anal fissure (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anal-fissure-beyond-the-basics/print

  Nitroglycerin also results in a reduction in pressure of the internal anal sphincter, which decreases pain and further facilitates healing. […] Botulinum toxin — Botulinum toxin is a neurotoxin produced by a bacterium, Clostridium botulinum. It temporarily paralyzes muscles for up to three months, and it can be injected into the internal anal sphincter muscle in a clinician’s office without anesthesia or sedation. […] Surgery — Surgical procedures are generally reserved for people with symptoms that have persisted despite medical therapy for at least one to three months. The procedure of choice is called a lateral internal sphincterotomy, which relaxes the internal anal sphincter by cutting this muscle. […] Comparison among surgery and nitroglycerin, botulinum toxin, and nifedipine or diltiazem reveals that surgery has a higher success rate.

• #44 Anal Fissure – Little Wound, Major Pain | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/bangkok/content/anal-fissure

  Surgical Treatment is suitable for patients who suffered from anal fissure for more than 6-8 weeks and medication does not make it better or symptoms persisted when stop medication. A lateral internal sphincterotomy is a minimally invasive surgery about 1 cm in size to correct the internal sphincter that is inflamed and contracted while saving the external sphincter. The benefits of this treatment include: Local or spinal anesthesia without the need for systemic anesthesia, Short hospital stay and quicker recovery, 95% chance of a cure, Hemorrhoid can be corrected at the same time. […] Anal fissure is common but the pain is high. Prevent constipation and take time to pass bowel movement. If symptoms persist, please consult a specialist to diagnose and treat anal fissure during the early stages. Patients who have chronic anal fissure should get suitable treatment. For patients who require surgery, minimally invasive surgery can result in less pain, quicker recovery and increased chance of a cure. Lastly, patients no longer need to withstand pain during a bowel movement.

• #45

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure-expanded-information

  Precise and controlled division of the internal anal sphincter muscle is a highly effective and commonly used method to treat chronic and refractory anal fissures, with success rates reported to be over 90%. Recurrence rates after sphincterotomy are exceedingly low when properly performed by a surgeon. The surgery is performed as an outpatient, same-day procedure. The main risks of internal sphincterotomy are variable degrees of stool or gas incontinence. If any incontinence is present after surgery, it may resolve over a short time period. Patients undergoing sphincterotomy have much improved quality of life as compared to patients with persistent anal fissures. Your colon and rectal surgeon will go over each of the potential risks and benefits of sphincterotomy and will decide if this procedure is right for you.

• #46 Anal Fissure – Little Wound, Major Pain | Bangkok Hospital Headquarter

  https://www.bangkokhospital.com/en/bangkok/content/anal-fissure

  Surgical Treatment is suitable for patients who suffered from anal fissure for more than 6-8 weeks and medication does not make it better or symptoms persisted when stop medication. A lateral internal sphincterotomy is a minimally invasive surgery about 1 cm in size to correct the internal sphincter that is inflamed and contracted while saving the external sphincter. The benefits of this treatment include: Local or spinal anesthesia without the need for systemic anesthesia, Short hospital stay and quicker recovery, 95% chance of a cure, Hemorrhoid can be corrected at the same time. […] Anal fissure is common but the pain is high. Prevent constipation and take time to pass bowel movement. If symptoms persist, please consult a specialist to diagnose and treat anal fissure during the early stages. Patients who have chronic anal fissure should get suitable treatment. For patients who require surgery, minimally invasive surgery can result in less pain, quicker recovery and increased chance of a cure. Lastly, patients no longer need to withstand pain during a bowel movement.

• #47 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Lateral internal sphincterotomy is the gold standard against which all treatments are compared. […] A study comparing open vs closed sphincterotomy did not show any significant difference in the healing rates (95% for open vs 97% for closed) and incontinence rates. The recurrence rates range from 0% to 15.4%, although the majority of studies report rates of 0% to 3.3%. […] The recommended treatment algorithm was shown in Figure 1. Pharmacological therapies such as 0.2% GTN, 2% Diltiazem ointment or Botulinum toxin injection can be tried as initial treatment for chronic anal fissures. The perineal support device provides an interesting and non-invasive approach to treating chronic fissures by decreasing anal mucosa trauma and can be an adjuvant to pharmacological therapies. […] In cases of failure of all pharmacological therapy options or discontinuation due to complications, lateral internal sphincterotomy should be offered. Division of the internal sphincter up to the apex of the fissure will help minimize anal incontinence.

• #48 Anal Fissure – Saleeby and Wessels Proctology

  https://www.saleebyandwesselsproctology.com/colorectal-services/anal-fissure/

  Success for healing is expected in around 90-100% of cases. Recurrence is around 10%. […] Evaluation and consultation with a board certified colon and rectal surgeon experienced with each option is essential in choosing the treatment modality that maximizes the chances of healing, while minimizing recurrence and complications.

• #49 Anal Fissures: Causes and Prevention

  https://www.webmd.com/digestive-disorders/anal-fissure-causes

  Calcium channel blockers. These are blood pressure-lowering medications. Some of the topical ones can treat anal fissures, too. […] Topical anesthetic. Your doctor might suggest this if you have serious pain when you go to the bathroom. […] Botox shots. If topical treatments don’t work, injecting botulinum toxin type A (Botox) into the sphincter is sometimes the next step. […] You probably won’t need surgery for anal fissures unless other forms of treatment haven’t worked. The surgery, called a lateral internal sphincterotomy (LIS), involves making a small cut in the anal sphincter muscle. It reduces pain and pressure, allowing the fissure to heal. […] The pain from this surgery is usually mild. It can hurt less than the fissure itself. The surgery might be followed by temporarily not being able to control passing gas, a small amount of poop leakage, or an infection. But in most cases, complete healing of fissures takes place within 8 weeks after surgery.

• #50

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

  SURGICAL TREATMENT Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include Botulinum toxin (Botox) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures. […] POST-TREATMENT PROGNOSIS Most patients can return to work and go back to daily activities a few days after surgery. Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fiber diet. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing. Botox injections are associated with healing of chronic anal fissures in 50% to 80% of patients. Sphincterotomy is successful in more than 90% of patients. Although uncommon, this procedure may affect the patients ability to fully control gas or bowel movements.

• #51

  https://www.nhs.uk/conditions/anal-fissure/

  A GP can prescribe medicine to help relieve your symptoms and speed up the healing process. […] Surgery may be recommended in persistent cases of anal fissure where self-help measures and medicine have not helped. […] Surgery is often very effective at treating anal fissures, but it does carry a small risk of complications, such as temporary or permanent loss of bowel control (bowel incontinence). […] Anal fissures usually heal within a few weeks without the need for treatment. […] But they can easily come back if they’re caused by constipation that remains untreated. […] In some people, symptoms from anal fissures last 6 weeks or more (chronic anal fissures).

• #52 Anal fissure – symptoms, causes, and treatments | healthdirect

  https://www.healthdirect.gov.au/anal-fissure

  An anal fissure is a small tear or split in the skin that lines the anus. […] There are different treatment options for anal fissures. […] Most anal fissures will heal on their own. Conservative treatment aims to: reduce constipation, relieve the pain, heal the fissure. […] It involves eating lots of high-fibre foods and drinking lots of water to soften your stools (poos). Conservative treatment usually works in 6 to 8 weeks. […] Your doctor may also recommend: a stool softener, warm baths or sitz baths. […] If GTN doesn’t work, your doctor may prescribe a medicine called calcium channel blockers. […] Botox is another treatment option. It’s a chemical that’s injected into the muscles around your anus to help them relax. […] Your doctor may recommend surgery if other treatments have not been helpful. […] Anal fissure surgery is known as a lateral internal sphincterotomy. A small cut is made in your sphincter muscle, which relieves tension.

• #53 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Botulinum toxin (eg, onabotulinumtoxinA) has been used to treat acute and chronic anal fissures. It is injected directly into the internal anal sphincter, in effect performing a chemical sphincterotomy. […] Surgical therapy is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures. […] Lateral internal sphincterotomy is the current surgical procedure of choice for anal fissure. The purpose of the operation is to cut the hypertrophied internal sphincter, thereby releasing tension and allowing the fissure to heal. […] When treating a chronic anal fissure, the surgeon may elect to perform a fissurectomy in conjunction with the lateral sphincterotomy. […] Sphincterotomy is performed either in an outpatient setting or as an office procedure, and patients return home the same day.

• #54 Anal Fissures | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/surgery/general-and-gastrointestinal-surgery/colorectal-and-intestines-disorders/anal-fissures

  Board certified colon and rectal surgeons at Brigham and Womens Hospital (BWH) offer the most advanced and effective treatment for patients with anal fissures, including lifestyle recommendations, medication management and minimally invasive surgery such as sphincterotomy, a technique that releases pressure inside the anus and promotes healing of anal tissues. […] Depending upon the severity of your anal fissure, your colorectal surgeon will recommend an individualized treatment plan which can help relax the anal sphincter and promote healing. […] People whose anal fissures do not heal well may have an imbalance in anal pressure that prevents blood from circulating normally through the blood vessels around the anus. If symptoms persist, surgical treatment may be necessary: […] Lateral internal sphincterotomy A small portion of the distal internal sphincter is cut and divided to relieve chronic spasm. The procedure is successful in curing chronic anal fissures. Changes in continence can occur, so it is reserved for patients who have failed non-surgical treatments. […] Fissurectomy Excision of the fissure […] Anal advancement flap Covering the fissure with tissue from another part of the body […] Anal dilation Rare procedure that widens and stretches the anal canal.

• #55 Anal Fissures | Brigham and Women’s Hospital

  https://www.brighamandwomens.org/surgery/general-and-gastrointestinal-surgery/colorectal-and-intestines-disorders/anal-fissures

  Board certified colon and rectal surgeons at Brigham and Womens Hospital (BWH) offer the most advanced and effective treatment for patients with anal fissures, including lifestyle recommendations, medication management and minimally invasive surgery such as sphincterotomy, a technique that releases pressure inside the anus and promotes healing of anal tissues. […] Depending upon the severity of your anal fissure, your colorectal surgeon will recommend an individualized treatment plan which can help relax the anal sphincter and promote healing. […] People whose anal fissures do not heal well may have an imbalance in anal pressure that prevents blood from circulating normally through the blood vessels around the anus. If symptoms persist, surgical treatment may be necessary: […] Lateral internal sphincterotomy A small portion of the distal internal sphincter is cut and divided to relieve chronic spasm. The procedure is successful in curing chronic anal fissures. Changes in continence can occur, so it is reserved for patients who have failed non-surgical treatments. […] Fissurectomy Excision of the fissure […] Anal advancement flap Covering the fissure with tissue from another part of the body […] Anal dilation Rare procedure that widens and stretches the anal canal.

• #56 Chronic and Refractory Anal Fissure: What Are the Treatment Options? | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-42303-1_40

  Anal fissures are a common cause of perianal pain and are typically described as a knife-like pain worsened during defecation. Acute anal fissures are often successfully managed with conservative measures including fiber supplementation and stool softeners to allow soft, regular bowel movements, sitz baths, and topical analgesics. When the fissure lasts longer than 4 to 8 weeks, it is considered to be a chronic anal fissure. The first line therapy for chronic anal fissures is with fiber bulking and topical medications. Topical calcium channel blockers are recommended over topical nitric oxide donors due to its better side effect profile, leading to improved patient compliance. Botulinum toxin injection into the anal sphincter to decrease sphincter tone is a reasonable option that may be considered if medical therapy fails to result in healing of the fissure. However, the optimal dosage and injection protocol has not yet been well-established. Surgical intervention with a lateral internal sphincterotomy offers the highest healing rate and may be used when the anal fissure does not resolve with conservative therapy. Lateral internal sphincterotomy carries a small risk of temporary or even permanent gas or fecal incontinence, and therefore anal sphincter tone and risk factors for developing incontinence should be carefully assessed prior to consideration of sphincterotomy. Recurrent anal fissures after partial lateral internal sphincterotomy may be due to incomplete division of the sphincter muscle, so a repeat perianal examination should be performed and repeat sphincterotomy may be considered. In patients with a hypotonic anal sphincter who fail nonoperative management of their chronic anal fissure, anal advancement flap is recommended. Patients with atypical chronic anal fissures should undergo biopsy and management of the fissure should be directed towards the underlying etiology.

• #57 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Lateral internal sphincterotomy is the gold standard against which all treatments are compared. […] A study comparing open vs closed sphincterotomy did not show any significant difference in the healing rates (95% for open vs 97% for closed) and incontinence rates. The recurrence rates range from 0% to 15.4%, although the majority of studies report rates of 0% to 3.3%. […] The recommended treatment algorithm was shown in Figure 1. Pharmacological therapies such as 0.2% GTN, 2% Diltiazem ointment or Botulinum toxin injection can be tried as initial treatment for chronic anal fissures. The perineal support device provides an interesting and non-invasive approach to treating chronic fissures by decreasing anal mucosa trauma and can be an adjuvant to pharmacological therapies. […] In cases of failure of all pharmacological therapy options or discontinuation due to complications, lateral internal sphincterotomy should be offered. Division of the internal sphincter up to the apex of the fissure will help minimize anal incontinence.

• #58 Anal fissure – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/anal-fissure.html

  A recent Cochrane review reported that topical glyceryl trinitrate is better than placebo in healing anal fissures (healing rates 49% vs 36%). […] The reported healing rates of anal fissure following botulinum toxin injection are 6080% (superior to placebo). […] Surgery is considered for patients not responding to conservative measures. […] The gold standard surgical operation for anal fissure is lateral internal sphincterotomy. This procedure commonly involves division of the internal anal sphincter from its distal end to either the proximal end of the fissure or the dentate line (whichever comes first). […] When comparing lateral internal sphincterotomy to topical glyceryl trinitrate, calcium channel blockers and botulinum toxin injection, lateral internal sphincterotomy is clearly superior in terms of healing rates.

• #59 Non surgical therapy for anal fissure. | Cochrane

  https://www.cochrane.org/CD003431/COLOCA_non-surgical-therapy-for-anal-fissure.

  Because of the disability associated with surgery for anal fissure and the risk of incontinence, medical alternatives for surgery have been sought. Most recently, pharmacologic methods that relax the anal smooth muscle, to accomplish reversibly what occurs in surgery, have been used to obtain fissure healing. […] GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.9% vs. 35.5%, p 0.0009), but late recurrence of fissure was common, in the range of 50% of those initially cured. Botox and CCBs were equivalent to GTN in efficacy with fewer adverse events. No medical therapy came close to the efficacy of surgical sphincterotomy, though none of the medical therapies in these RCTs were associated with the risk of incontinence.

• #60 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Lateral internal sphincterotomy is the gold standard against which all treatments are compared. […] A study comparing open vs closed sphincterotomy did not show any significant difference in the healing rates (95% for open vs 97% for closed) and incontinence rates. The recurrence rates range from 0% to 15.4%, although the majority of studies report rates of 0% to 3.3%. […] The recommended treatment algorithm was shown in Figure 1. Pharmacological therapies such as 0.2% GTN, 2% Diltiazem ointment or Botulinum toxin injection can be tried as initial treatment for chronic anal fissures. The perineal support device provides an interesting and non-invasive approach to treating chronic fissures by decreasing anal mucosa trauma and can be an adjuvant to pharmacological therapies. […] In cases of failure of all pharmacological therapy options or discontinuation due to complications, lateral internal sphincterotomy should be offered. Division of the internal sphincter up to the apex of the fissure will help minimize anal incontinence.

• #61 Treatment Algorithm for Anal Fissure. Consensus Document of the Spanish Association of Coloproctology and the Coloproctology Division of the Spanish Association of Surgeons | Cirugía Española (English Edition)

  https://www.elsevier.es/en-revista-cirugia-espanola-english-edition–436-articulo-treatment-algorithm-for-anal-fissure–S2173507718301017

  The therapeutic algorithm for AF, published in 2016 in UpToDate, begins with hygiene-dietary measures and pharmacological support. […] The publication of the American Society of Colon and Rectal Surgeons concludes that the medical treatment of AF is safe, has few side effects and should be the first-line treatment. […] LIS is associated with clearly higher CAF healing rates compared to medical therapy and, therefore, may be offered in selected patients, even if drug treatment failure has not been confirmed. […] We can establish, with a Level of evidence 1A and a Grade of recommendation A: Evidence: surgical treatment is the second therapeutic step for CAF. […] Evidence: surgery is the most effective long-term treatment for CAF. […] Evidence: LIS continues to be the surgical technique of choice. […] Evidence: LIS is the technique of choice in patients with rejection, failure or complications after pharmacological therapy.

• #62 Chronic and Refractory Anal Fissure: What Are the Treatment Options? | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-42303-1_40

  Anal fissures are a common cause of perianal pain and are typically described as a knife-like pain worsened during defecation. Acute anal fissures are often successfully managed with conservative measures including fiber supplementation and stool softeners to allow soft, regular bowel movements, sitz baths, and topical analgesics. When the fissure lasts longer than 4 to 8 weeks, it is considered to be a chronic anal fissure. The first line therapy for chronic anal fissures is with fiber bulking and topical medications. Topical calcium channel blockers are recommended over topical nitric oxide donors due to its better side effect profile, leading to improved patient compliance. Botulinum toxin injection into the anal sphincter to decrease sphincter tone is a reasonable option that may be considered if medical therapy fails to result in healing of the fissure. However, the optimal dosage and injection protocol has not yet been well-established. Surgical intervention with a lateral internal sphincterotomy offers the highest healing rate and may be used when the anal fissure does not resolve with conservative therapy. Lateral internal sphincterotomy carries a small risk of temporary or even permanent gas or fecal incontinence, and therefore anal sphincter tone and risk factors for developing incontinence should be carefully assessed prior to consideration of sphincterotomy. Recurrent anal fissures after partial lateral internal sphincterotomy may be due to incomplete division of the sphincter muscle, so a repeat perianal examination should be performed and repeat sphincterotomy may be considered. In patients with a hypotonic anal sphincter who fail nonoperative management of their chronic anal fissure, anal advancement flap is recommended. Patients with atypical chronic anal fissures should undergo biopsy and management of the fissure should be directed towards the underlying etiology.

• #63

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

  SURGICAL TREATMENT Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include Botulinum toxin (Botox) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures. […] POST-TREATMENT PROGNOSIS Most patients can return to work and go back to daily activities a few days after surgery. Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fiber diet. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing. Botox injections are associated with healing of chronic anal fissures in 50% to 80% of patients. Sphincterotomy is successful in more than 90% of patients. Although uncommon, this procedure may affect the patients ability to fully control gas or bowel movements.

• #64 Anal fissure treatment – Recovery | Guy’s and St Thomas’ NHS Foundation Trust

  https://www.guysandstthomas.nhs.uk/health-information/anal-fissure-treatment/recovery

  Most people have surgery in the day surgery unit and can leave hospital on the same day. […] You should be able to go to the toilet normally and naturally after surgery. It is important to keep your poo (stool) soft. This can prevent any damage to your anus and ease your pain. […] We will give you laxatives to help you go to the toilet. Laxatives help you to open your bowels to have a poo. They also help to keep your poo (stools) soft. […] Increasing the amount of fibre in your diet can soften your poo and help you go to the toilet more easily. You can do this by eating more fruit and vegetables and increasing the amount of water and fluids that you drink. […] Try to eat lots of high-fibre foods, such as muesli, brown rice or pasta, prunes and other fruits and vegetables. This helps to prevent the anal fissures from returning.

• #65 Anal Fissure – Anal Fissure Causes | familydoctor.org

  https://familydoctor.org/condition/anal-fissures/

  People who develop fissures once are more likely to have them in the future, so it’s important to keep bowel movements regular. If you’ve had a fissure in the past, you may be tempted to hold your bowel movement in to avoid the pain of passing it. But that’s not a good idea. That can make stools become hard and difficult to pass, which will make the fissure worse. Continue with a high-fiber diet and drink plenty of liquid to help make stools easy to pass.

• #66 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  Anal fissures typically cause pain and bleeding with bowel movements. […] Most anal fissures get better with simple treatments, such as eating more fiber or soaking in a warm-water bath. Some people with anal fissures may need medicine. Sometimes, surgery may be necessary. […] You may be able to prevent an anal fissure by taking measures to prevent constipation or diarrhea. Eat high-fiber foods, drink fluids, and exercise regularly to keep from having to strain during bowel movements. […] An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment. […] An unhealed fissure may trigger a cycle of discomfort that may require medicines or surgery to ease the pain and to repair or remove the fissure.

• #67 Anal Fissure: Treatment, Symptoms, Causes, Healing, and More

  https://www.healthline.com/health/anal-fissure

  A calcium channel blocker ointment can relax the sphincter muscles and allow the anal fissure to heal. […] Another possible treatment is Botox injections into the anal sphincter. The injections will prevent spasms in your anus by temporarily paralyzing the muscle. This allows the anal fissure to heal while preventing new fissures from forming. […] If your anal fissure fails to respond to other treatments, your doctor may recommend an anal sphincterotomy. This surgical procedure involves making a small incision in the anal sphincter to relax the muscle. Relaxing the muscle allows the anal fissure to heal. […] Most anal fissures will heal without surgical intervention. Anal fissures are open wounds, so keeping the area clean and dry will assist in the body’s natural healing processes. […] Eating a high-fiber diet, drinking plenty of fluids, taking sitz baths, and using anti-inflammatory ointments can help current fissures heal and prevent new ones. […] You can normally treat anal fissures at home with good wound hygiene, and avoid recurrences by making small dietary and lifestyle changes.

• #68 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Complications from surgery for anal fissure include the following: Infection, Bleeding, Fistula development, Incontinence (the most feared complication). […] Stool softeners and fiber supplementation should be prescribed after the surgical procedure, and fiber supplementation should be recommended indefinitely to prevent future problems with constipation.

• #69 Anal fissure – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/anal-fissure/symptoms-causes/syc-20351424

  Anal fissures typically cause pain and bleeding with bowel movements. […] Most anal fissures get better with simple treatments, such as eating more fiber or soaking in a warm-water bath. Some people with anal fissures may need medicine. Sometimes, surgery may be necessary. […] You may be able to prevent an anal fissure by taking measures to prevent constipation or diarrhea. Eat high-fiber foods, drink fluids, and exercise regularly to keep from having to strain during bowel movements. […] An anal fissure that fails to heal within eight weeks is considered chronic and may need further treatment. […] An unhealed fissure may trigger a cycle of discomfort that may require medicines or surgery to ease the pain and to repair or remove the fissure.

• #70

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

  SURGICAL TREATMENT Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include Botulinum toxin (Botox) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures. […] POST-TREATMENT PROGNOSIS Most patients can return to work and go back to daily activities a few days after surgery. Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fiber diet. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing. Botox injections are associated with healing of chronic anal fissures in 50% to 80% of patients. Sphincterotomy is successful in more than 90% of patients. Although uncommon, this procedure may affect the patients ability to fully control gas or bowel movements.

• #71 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Complications from surgery for anal fissure include the following: Infection, Bleeding, Fistula development, Incontinence (the most feared complication). […] Stool softeners and fiber supplementation should be prescribed after the surgical procedure, and fiber supplementation should be recommended indefinitely to prevent future problems with constipation.

• #72 Anal Fissure: What It Is, Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/13177-anal-fissures

  Most do. These are acute anal fissures (temporary). They might not need any treatment at all, beyond self-care. Or you might only need a prescription cream for temporary pain relief, like lidocaine. But if your fissure hasn’t healed after several weeks, it needs treatment. […] When you have a chronic anal fissure one that has lasted more than eight weeks medical treatment focuses on relaxing the anal sphincter muscles that surround your anal canal. This should allow the fissure to begin to close and help restore blood flow to the tissues. […] Medications for anal fissures include: Nitroglycerin ointment. Nitroglycerin is a vasodilator, a medicine that makes your blood vessels expand. Applied as a cream, it can restore blood flow and can help your anal sphincter relax. However, it can cause headaches, and some people have to discontinue it for this reason.

• #73 Management of Anal Fissures: Guidelines From the American Society of Colon and Rectal Surgeons | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0200/practice-guidelines-anal-fissures.html

  Conservative therapy with bulking supplements and sitz baths leads to resolution of acute anal fissures in approximately one-half of patients. […] Although topical calcium channel blockers and nitroglycerin lead to resolution of approximately one-half of chronic anal fissures, topical calcium channel blockers have fewer adverse effects, such as headache. […] Botulinum toxin injections are as effective as topical therapies but can lead to transient fecal incontinence in 5% of treated patients. […] The American Society of Colon and Rectal Surgeons has released guidelines for the treatment of anal fissures.

• #74 Management of Anal Fissures: Guidelines From the American Society of Colon and Rectal Surgeons | AAFP

  https://www.aafp.org/pubs/afp/issues/2024/0200/practice-guidelines-anal-fissures.html

  Conservative therapy with bulking supplements and sitz baths leads to resolution of acute anal fissures in approximately one-half of patients. […] Although topical calcium channel blockers and nitroglycerin lead to resolution of approximately one-half of chronic anal fissures, topical calcium channel blockers have fewer adverse effects, such as headache. […] Botulinum toxin injections are as effective as topical therapies but can lead to transient fecal incontinence in 5% of treated patients. […] The American Society of Colon and Rectal Surgeons has released guidelines for the treatment of anal fissures.

• #75 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Complications from surgery for anal fissure include the following: Infection, Bleeding, Fistula development, Incontinence (the most feared complication). […] Stool softeners and fiber supplementation should be prescribed after the surgical procedure, and fiber supplementation should be recommended indefinitely to prevent future problems with constipation.

• #76 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Complications from surgery for anal fissure include the following: Infection, Bleeding, Fistula development, Incontinence (the most feared complication). […] Stool softeners and fiber supplementation should be prescribed after the surgical procedure, and fiber supplementation should be recommended indefinitely to prevent future problems with constipation.

• #77 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Complications from surgery for anal fissure include the following: Infection, Bleeding, Fistula development, Incontinence (the most feared complication). […] Stool softeners and fiber supplementation should be prescribed after the surgical procedure, and fiber supplementation should be recommended indefinitely to prevent future problems with constipation.

• #78 Anal Fissure Treatment & Management: Approach Considerations, Medical Therapy, Surgical Therapy

  https://emedicine.medscape.com/article/196297-treatment

  Complications from surgery for anal fissure include the following: Infection, Bleeding, Fistula development, Incontinence (the most feared complication). […] Stool softeners and fiber supplementation should be prescribed after the surgical procedure, and fiber supplementation should be recommended indefinitely to prevent future problems with constipation.

• #79 Patient education: Anal fissure (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/anal-fissure-beyond-the-basics/print

  Nitroglycerin also results in a reduction in pressure of the internal anal sphincter, which decreases pain and further facilitates healing. […] Botulinum toxin — Botulinum toxin is a neurotoxin produced by a bacterium, Clostridium botulinum. It temporarily paralyzes muscles for up to three months, and it can be injected into the internal anal sphincter muscle in a clinician’s office without anesthesia or sedation. […] Surgery — Surgical procedures are generally reserved for people with symptoms that have persisted despite medical therapy for at least one to three months. The procedure of choice is called a lateral internal sphincterotomy, which relaxes the internal anal sphincter by cutting this muscle. […] Comparison among surgery and nitroglycerin, botulinum toxin, and nifedipine or diltiazem reveals that surgery has a higher success rate.

• #80

  https://fascrs.org/patients/diseases-and-conditions/a-z/anal-fissure

  SURGICAL TREATMENT Although most anal fissures do not require surgery, chronic fissures are harder to treat and surgery may be the best option. The goal of surgery is to help the anal sphincter muscles relax which reduces pain and spasms, allowing the fissure to heal. Surgical options include Botulinum toxin (Botox) injection into the anal sphincter or surgical division of an inner part of the anal sphincter (lateral internal sphincterotomy). Your colon and rectal surgeon will find the best treatment for you and discuss the risks of surgery. Both types of surgery are typically done as same-day outpatient procedures. […] POST-TREATMENT PROGNOSIS Most patients can return to work and go back to daily activities a few days after surgery. Complete healing after both medical and surgical treatments can take 6 to 10 weeks. Even when the pain and bleeding lessen, it is important to maintain good bowel habits and eat a high-fiber diet. Continued hard or loose bowel movements, scarring, or spasm of the internal anal muscle can delay healing. Botox injections are associated with healing of chronic anal fissures in 50% to 80% of patients. Sphincterotomy is successful in more than 90% of patients. Although uncommon, this procedure may affect the patients ability to fully control gas or bowel movements.

• #81 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Lateral internal sphincterotomy is the gold standard against which all treatments are compared. […] A study comparing open vs closed sphincterotomy did not show any significant difference in the healing rates (95% for open vs 97% for closed) and incontinence rates. The recurrence rates range from 0% to 15.4%, although the majority of studies report rates of 0% to 3.3%. […] The recommended treatment algorithm was shown in Figure 1. Pharmacological therapies such as 0.2% GTN, 2% Diltiazem ointment or Botulinum toxin injection can be tried as initial treatment for chronic anal fissures. The perineal support device provides an interesting and non-invasive approach to treating chronic fissures by decreasing anal mucosa trauma and can be an adjuvant to pharmacological therapies. […] In cases of failure of all pharmacological therapy options or discontinuation due to complications, lateral internal sphincterotomy should be offered. Division of the internal sphincter up to the apex of the fissure will help minimize anal incontinence.

• #82 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Lateral internal sphincterotomy is the gold standard against which all treatments are compared. […] A study comparing open vs closed sphincterotomy did not show any significant difference in the healing rates (95% for open vs 97% for closed) and incontinence rates. The recurrence rates range from 0% to 15.4%, although the majority of studies report rates of 0% to 3.3%. […] The recommended treatment algorithm was shown in Figure 1. Pharmacological therapies such as 0.2% GTN, 2% Diltiazem ointment or Botulinum toxin injection can be tried as initial treatment for chronic anal fissures. The perineal support device provides an interesting and non-invasive approach to treating chronic fissures by decreasing anal mucosa trauma and can be an adjuvant to pharmacological therapies. […] In cases of failure of all pharmacological therapy options or discontinuation due to complications, lateral internal sphincterotomy should be offered. Division of the internal sphincter up to the apex of the fissure will help minimize anal incontinence.

• #83 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Lateral internal sphincterotomy is the gold standard against which all treatments are compared. […] A study comparing open vs closed sphincterotomy did not show any significant difference in the healing rates (95% for open vs 97% for closed) and incontinence rates. The recurrence rates range from 0% to 15.4%, although the majority of studies report rates of 0% to 3.3%. […] The recommended treatment algorithm was shown in Figure 1. Pharmacological therapies such as 0.2% GTN, 2% Diltiazem ointment or Botulinum toxin injection can be tried as initial treatment for chronic anal fissures. The perineal support device provides an interesting and non-invasive approach to treating chronic fissures by decreasing anal mucosa trauma and can be an adjuvant to pharmacological therapies. […] In cases of failure of all pharmacological therapy options or discontinuation due to complications, lateral internal sphincterotomy should be offered. Division of the internal sphincter up to the apex of the fissure will help minimize anal incontinence.

• #84

  https://journals.lww.com/ajg/abstract/2019/10001/1522_energy_therapy_an_alternative_treatment_of.1522.aspx

  Energy Therapy has been a well known non-surgical, minimally invasive treatment option for symptomatic grades I and II internal hemorrhoids. This treatment has not yet been studied in anal fissures refractory to medical therapy. Currently, only a few non-surgical treatments are available for anal fissures which involve conservative and supportive measures that include: increasing dietary fiber intake, stool softeners, sitz baths, topical analgesics or vasodilators. We propose the use of hemorrhoid energy therapy (HET) with bipolar cautery as a safer, less invasive and effective therapy for recurrent anal fissures refractory to conservative management. […] The delivery of energy to a targeted region with temperatures between 50 to 55 C along with compression of the tissue can help obtain homeostasis for bleeding or CAF along with change of histology to mild scarring with fibrosis and occlusion of blood supply which would result in healing of the fissure. This intervention using bipolar cautery which could be an alternative treatment as a safer, less invasive and effective therapy for recurrent anal fissures refractory to conservative management prior to considering surgery. Our patient was followed up 2 years after the procedure with no recurrences of anal fissures or rectal bleeding, and reported improved quality of life with no complications from the procedure.

• #85 Anal fissure – Dr Philippe Bull

  https://www.dr-bull.at/en/anal-fissure/

  What is the treatment for an anal fissure? […] Treatment aims to ease the pain and keep the faeces soft whilst the fissure heals. […] Most acute anal fissures can heal with home treatment in 4 to 6 weeks. […] Medication and fibres are usually the first-line treatment for chronic fissures. […] Glyceryl trinitrate or Calcium channel antagonists ointment […] About 7 in 10 people with a chronic anal fissure are cured with a course of GTN ointment. […] Surgery is an option if GTN treatment does not work. […] The usual operation is to make a small cut in the muscle around the anus (internal sphincterotomy). […] The removal of hypertrophied anal papillae and fibrous anal polyps should be made an essential part of treatment of chronic fissures in ano. […] Laser-assisted procedures have been found useful in successfully eradicating these concomitant pathologies of chronic anal fissure. […] The best way to avoid a further fissure is to avoid constipation by using the measures described above.

• #86 Innovations in chronic anal fissure treatment: A systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2999245/

  Novel therapies such as Gonyautoxin injection, controlled anal dilatation, sphincterolysis, fissurectomy and fissurotomy are not well established treatments and will need further research before their roles in the treatment of chronic anal fissures can be determined. In the event of failure of both pharmacological therapy and lateral sphincterotomy, these novel therapies can be attempted.

• #87 Anal Fissures – Children’s Hospital of Orange County

  https://choc.org/programs-services/gastroenterology/constipation/anal-fissures/

  Treatments for anal fissures may include: Changing your child’s diet to increase fiber and water to help regulate his or her bowel movements and reduce both diarrhea and constipation. Learn more about adding fiber to your child’s diet. Taking warm baths for up to 20 minutes a day. Taking stool softeners, such as fiber supplements, as needed. Taking medications, such as nitrates or calcium blockers. Having surgery, such as a lateral internal sphincterectomy. This surgery releases pressure inside the anus, allowing more blood to flow through the area to heal and protect tissues.

• #88 Anal fissure: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001130.htm

  Most fissures heal on their own and do not need treatment. […] To prevent or treat anal fissures in infants, be sure to change diapers often and clean the area gently. […] Worrying about pain during a bowel movement may cause a person to avoid them. But not having bowel movements will only cause the stools to become even harder, which can make the anal fissure worse. […] Prevent hard stools and constipation by: Making dietary changes — eating more fiber or bulk, such as fruits, vegetables, and grains; Drinking more fluids; Using stool softeners. […] Ask your provider about the following ointments or creams to help soothe the affected skin: Numbing cream, if pain interferes with normal bowel movements; Petroleum jelly; Zinc oxide, 1% hydrocortisone cream, Preparation H, and other products.

• #89 Anal Fissure | Riley Children’s Health

  https://www.rileychildrens.org/health-info/anal-fissure

  An anal fissure is a tear in the opening at the end of the gastrointestinal tract, called the anus. […] Most anal fissures will heal without treatment over time. Several home treatments can aid healing. Your child’s physician may recommend the following: Sitz bath. Sitting in a warm bath for 20 minutes, two or three times a day can ease pain and promote healing. Ointments. Application of petroleum jelly or zinc oxide ointment can reduce itching and discomfort. Stool softener. Use of a stool softener can make bowel movements easier and less painful. […] The U.S. National Library of Medicine website provides information for patients and families about the causes of and treatments for anal fissures.

• #90 Anal Fissure | Riley Children’s Health

  https://www.rileychildrens.org/health-info/anal-fissure

  An anal fissure is a tear in the opening at the end of the gastrointestinal tract, called the anus. […] Most anal fissures will heal without treatment over time. Several home treatments can aid healing. Your child’s physician may recommend the following: Sitz bath. Sitting in a warm bath for 20 minutes, two or three times a day can ease pain and promote healing. Ointments. Application of petroleum jelly or zinc oxide ointment can reduce itching and discomfort. Stool softener. Use of a stool softener can make bowel movements easier and less painful. […] The U.S. National Library of Medicine website provides information for patients and families about the causes of and treatments for anal fissures.

• #91 What is a chronic anal fissure? | Information for the public | Chronic anal fissure: 2% topical diltiazem hydrochloride | Advice | NICE

  https://www.nice.org.uk/advice/esuom3/ifp/chapter/what-is-a-chronic-anal-fissure

  If the person has had to stop treatment with GTN, or the fissure hasn’t healed or has come back, other treatments can be tried. These include botulinum toxin injections (such as Botox or other brands) into the area around the anus (back passage) or a surgical procedure called spincterotomy. Both these treatments help the ring muscle (sphincter) to relax and allow more blood to flow to the lining of the anus (back passage). Diltiazem hydrochloride cream or ointment can also be tried. It is also sometimes used in children; there is no licensed medicine for treating chronic anal fissures in children.

• #92 Diagnosis and Management of Patients with Anal Fissures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0401/p1608.html

  Patients with anal fissures usually present with pain and bleeding. […] Increased fiber and fluid intake, sitz baths, and topical analgesics are the usual measures used in the management of acute fissures, and most fissures heal with minimal care. […] Further treatment options include surgery, topical therapy, and botulin toxin. […] Topical therapy includes nitroglycerin ointment or topical calcium channel blockers to decrease the resting anal pressure, but these preparations are not presently available in the United States. […] Treatment in patients with Crohn’s disease can be more aggressive, but surgery should be withheld initially because of the potential of incontinence or disease progression requiring proctectomy. […] The statement and review conclude by noting that conservative therapy is risk-free but may take longer to achieve symptom relief.

• #93 Diagnosis and Management of Patients with Anal Fissures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0401/p1608.html

  Patients with anal fissures usually present with pain and bleeding. […] Increased fiber and fluid intake, sitz baths, and topical analgesics are the usual measures used in the management of acute fissures, and most fissures heal with minimal care. […] Further treatment options include surgery, topical therapy, and botulin toxin. […] Topical therapy includes nitroglycerin ointment or topical calcium channel blockers to decrease the resting anal pressure, but these preparations are not presently available in the United States. […] Treatment in patients with Crohn’s disease can be more aggressive, but surgery should be withheld initially because of the potential of incontinence or disease progression requiring proctectomy. […] The statement and review conclude by noting that conservative therapy is risk-free but may take longer to achieve symptom relief.

• #94 Diagnosis and Management of Patients with Anal Fissures | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0401/p1608.html

  Patients with anal fissures usually present with pain and bleeding. […] Increased fiber and fluid intake, sitz baths, and topical analgesics are the usual measures used in the management of acute fissures, and most fissures heal with minimal care. […] Further treatment options include surgery, topical therapy, and botulin toxin. […] Topical therapy includes nitroglycerin ointment or topical calcium channel blockers to decrease the resting anal pressure, but these preparations are not presently available in the United States. […] Treatment in patients with Crohn’s disease can be more aggressive, but surgery should be withheld initially because of the potential of incontinence or disease progression requiring proctectomy. […] The statement and review conclude by noting that conservative therapy is risk-free but may take longer to achieve symptom relief.

• #95 Chronic and Refractory Anal Fissure: What Are the Treatment Options? | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-031-42303-1_40

  Anal fissures are a common cause of perianal pain and are typically described as a knife-like pain worsened during defecation. Acute anal fissures are often successfully managed with conservative measures including fiber supplementation and stool softeners to allow soft, regular bowel movements, sitz baths, and topical analgesics. When the fissure lasts longer than 4 to 8 weeks, it is considered to be a chronic anal fissure. The first line therapy for chronic anal fissures is with fiber bulking and topical medications. Topical calcium channel blockers are recommended over topical nitric oxide donors due to its better side effect profile, leading to improved patient compliance. Botulinum toxin injection into the anal sphincter to decrease sphincter tone is a reasonable option that may be considered if medical therapy fails to result in healing of the fissure. However, the optimal dosage and injection protocol has not yet been well-established. Surgical intervention with a lateral internal sphincterotomy offers the highest healing rate and may be used when the anal fissure does not resolve with conservative therapy. Lateral internal sphincterotomy carries a small risk of temporary or even permanent gas or fecal incontinence, and therefore anal sphincter tone and risk factors for developing incontinence should be carefully assessed prior to consideration of sphincterotomy. Recurrent anal fissures after partial lateral internal sphincterotomy may be due to incomplete division of the sphincter muscle, so a repeat perianal examination should be performed and repeat sphincterotomy may be considered. In patients with a hypotonic anal sphincter who fail nonoperative management of their chronic anal fissure, anal advancement flap is recommended. Patients with atypical chronic anal fissures should undergo biopsy and management of the fissure should be directed towards the underlying etiology.

• #96 Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes

  https://coloproctol.org/DOIx.php?id=10.3393/ac.2014.30.3.132

  Topical diltiazem 2% ointment was used as it appears to be at least equally efficacious as GTN but with fewer side-effects. […] Failure of treatment with topical diltiazem resulted in a fissurectomy and Botox injection. […] A second cycle of topical cream or a fissurectomy Botox injection can sometimes avoid a subsequent sphincterotomy. […] In conclusion, conservative therapy for a chronic anal fissure includes medical and surgical techniques. A stepwise approach to treatment that incorporates medical and surgical treatments is time consuming and requires patient counseling, but ultimately such an approach can successfully preserve the integrity of the anal sphincter muscle for the majority of patients. Recurrences are common, so long-term follow-ups of patients who underwent conservative therapies are required to fully assess the efficacy of treatment.

• #97 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Treatment.aspx

  While most patients will not require surgery for an anal fissure, it is recommended for chronic cases when other methods have failed to bring about healing. […] Surgery is very effective, with more than 90% of patients reporting positive long-term results. However, it is also associated with a small risk of complications such as bowel incontinence. […] Several different surgical techniques may be used: Lateral sphincterotomy is a procedure which involves making a small incision in the sphincter muscles to reduce the muscle spasm, and therefore lower the likelihood of recurrence. Advancement anal flap procedure involves using healthy tissue from the anal region to repair the anal fissure. […] Most patients will require a follow-up appointment several weeks after treatment, depending on the severity of the anal fissure and the technique used. Future treatment decisions, if needed, are made on a case-by-case basis, according to the symptoms and previous treatments of the patient. Ongoing care is important for severe anal fissures because the likelihood of recurrence is high.

• #98 The signs an fissure is healing and treatments

  https://www.medicalnewstoday.com/articles/signs-a-fissure-is-healing

  Like other injuries, the signs that an anal fissure is healing are when it no longer bleeds or causes pain and when the wound starts to close. […] Some fissures heal independently with some lifestyle changes, while others need medical or surgical treatment. […] The initial management of anal fissures includes lifestyle changes, and the goal is to prevent their recurrence. Options for managing them include adequate fluid intake, avoiding diuretics such as caffeine, sitz baths, a high fiber diet, stool softeners and laxatives. […] If these do not work, doctors may prescribe medications to combine with the lifestyle modifications, including topical analgesics, such as lidocaine, topical nitric oxide such as nitroglycerin, topical nifedipine, topical calcium blockers. […] If medications do not improve the condition, the doctor may recommend surgery. The gold standard surgery for chronic anal fissures is a lateral internal sphincterotomy, a surgical technique that aims to repair an anal fissure. […] If a person’s anal fissure does not heal with home remedies or medications, individuals may consider surgery as an option to promote healing.

• #99 Sphincter-Preserving Therapy for Treating a Chronic Anal Fissure: Long-term Outcomes

  https://coloproctol.org/DOIx.php?id=10.3393/ac.2014.30.3.132

  To estimate the risk of recurrent fissure in ano after sphincter preserving treatments. […] The vast majority of patients with chronic anal fissure can be treated with sphincter conserving treatments. This may require several interventions before healing can be achieved. Assessment for recurrence after 'conservative’ treatments requires a minimum of two-year follow-up. […] A reversible chemical sphincterotomy using topical glyceryl trinitrate (GTN) was described as a potential medical therapy for chronic anal fissure in 1991. […] A lateral sphincterotomy results in superior healing rates and remains the gold standard treatment for chronic anal fissure. […] Anal advancement flaps and botulinum A toxin (Botox) injection combined with a fissurectomy represent alternative surgical approaches that preserve anal sphincter integrity.

• #100 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Treatment.aspx

  While most patients will not require surgery for an anal fissure, it is recommended for chronic cases when other methods have failed to bring about healing. […] Surgery is very effective, with more than 90% of patients reporting positive long-term results. However, it is also associated with a small risk of complications such as bowel incontinence. […] Several different surgical techniques may be used: Lateral sphincterotomy is a procedure which involves making a small incision in the sphincter muscles to reduce the muscle spasm, and therefore lower the likelihood of recurrence. Advancement anal flap procedure involves using healthy tissue from the anal region to repair the anal fissure. […] Most patients will require a follow-up appointment several weeks after treatment, depending on the severity of the anal fissure and the technique used. Future treatment decisions, if needed, are made on a case-by-case basis, according to the symptoms and previous treatments of the patient. Ongoing care is important for severe anal fissures because the likelihood of recurrence is high.

• #101 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Anal-Fissures-Treatment.aspx

  While most patients will not require surgery for an anal fissure, it is recommended for chronic cases when other methods have failed to bring about healing. […] Surgery is very effective, with more than 90% of patients reporting positive long-term results. However, it is also associated with a small risk of complications such as bowel incontinence. […] Several different surgical techniques may be used: Lateral sphincterotomy is a procedure which involves making a small incision in the sphincter muscles to reduce the muscle spasm, and therefore lower the likelihood of recurrence. Advancement anal flap procedure involves using healthy tissue from the anal region to repair the anal fissure. […] Most patients will require a follow-up appointment several weeks after treatment, depending on the severity of the anal fissure and the technique used. Future treatment decisions, if needed, are made on a case-by-case basis, according to the symptoms and previous treatments of the patient. Ongoing care is important for severe anal fissures because the likelihood of recurrence is high.

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