Surgical procedures are generally reserved for people with anal fissure who have tried medical therapy for at least one to three months and have not healed. Ĭombination of medical therapies may offer up to 98% cure rates. Lateral sphincterotomy is the Gold Standard for curing this condition. However, in many cases involving Botox injections, the patients eventually had to choose another cure as the injections proved less and less potent, spending thousands of dollars in the meantime for a partial cure. This treatment was first investigated in 1993. A common side effect drawback of nitroglycerine ointment is headache, caused by systemic absorption of the drug, which limits patient acceptability.Ī combined surgical and pharmacological treatment, administered by colorectal surgeons, is the direct injection of botulinum toxin (Botox) into the anal sphincter to relax it. īranded preparations are now available of topical nitroglycerine ointment (Rectogesic (Rectiv) as 0.2% in Australia and 0.4% in UK and US ), topical nifedipine 0.3% with lidocaine 1.5% ointment (Antrolin in Italy since April 2004) and diltiazem 2% (Anoheal in UK, although still in Phase III development). Local application of medication to relax the sphincter muscle, thus allowing the healing to proceed, was first proposed in 1994 with nitroglycerine ointment, Īnd then calcium channel blockers in 1999 with nifedipine ointment, Īnd the following year with topical diltiazem. Other measures include warm sitz baths, topical anesthetics, high-fiber diet and stool softeners. diltiazem), or injection of botulinum toxin into the anal sphincter. These include topical nitroglycerin or calcium channel blockers (e.g. Non-surgical treatments are recommended initially for acute and chronic anal fissures. In infants, once an anal fissure has occurred, addressing underlying causes is usually enough to ensure healing occurs. breastmilk, proper ratios when mixing formulas) is beneficial. As constipation can be a cause, making sure the infant is drinking enough fluids (i.e. In infants, frequent diaper change can prevent anal fissure. In cases of pre-existing or suspected fissure, use of a lubricating ointment (It is important to note that hemorrhoid ointment is contraindicated because it constricts small blood vessels, thus causes a decrease in blood flow, which prevents healing).Careful anal hygiene after defecation, including using soft toilet paper and cleaning with water, plus the use of sanitary wipes.Similarly, prompt treatment of diarrhea may reduce anal strain. This includes treating and preventing constipation by eating food rich in dietary fiber, drinking enough water, occasional use of a stool softener, and avoiding constipating agents. Note that colonoscopy, sigmoidoscopy, or normal proctoscopy is for diagnosing internal hemorrhoids and other internal rectal diseases and not for diagnosing anal fissures.įor adults, the following may help prevent anal fissures: Narrow anal fissures might not be felt by finger during rectal examination due to the glove. Internal anal fissures in adults on anterior side, posterior side or within any part of the inner circumference of the anal sphincter muscle can be diagnosed with beak proctoscope 23mm diameter, Chelsea Eaton anal speculum 23mm diameter, Park anal retractor or by digital rectal examination with a finger inside the anal sphincter muscle. Other common causes of anal fissures include:Įxternal anal fissures on the anal verge can be diagnosed by visual inspection. Examples of sexually transmitted infections that may affect the anorectal area are syphilis, herpes, chlamydia and human papilloma virus. Some sexually transmitted infections can promote the breakdown of tissue resulting in a fissure. When fissures are found laterally, tuberculosis, occult abscesses, leukemic infiltrates, carcinoma, acquired immunodeficiency syndrome (AIDS) or inflammatory bowel disease should be considered as causes. In older adults, anal fissures may be caused by decreased blood flow to the area. In adults, fissures may be caused by constipation, the passing of large, hard stools, or by prolonged diarrhea. The result is a non-healing ulcer, which may become infected by fecal bacteria. The most common cause of non-healing is spasming of the internal anal sphincter muscle which results in impaired blood supply to the anal mucosa. However, some anal fissures become chronic and deep and will not heal. Superficial or shallow anal fissures look much like a paper cut, and may be hard to detect upon visual inspection they will generally self-heal within a couple of weeks. Most anal fissures are caused by stretching of the anal mucous membrane beyond its capability.
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