Current treatment options for fissure-in-ano.
BACKGROUND
Fissure-in-ano is a painful condition that affects a sizable majority of the population. Selecting a method of treating the condition that could achieve optimal clinical results and the least pain and inconvenience to the patient has always posed a challenge to the surgeons. This led to the innovation of a number of surgical and pharmacological methods that relax the anal muscle. While acute fissures could be managed with medical therapy alone, chronic fissures do need some form of manipulation to relieve internal sphincter spasm.


METHODS
The present study discusses various techniques advocated for the treatment of acute and chronic fissure-in-ano. It also elaborates on the advantages and deficiencies of each.


CONCLUSIONS
Despite the initial success with pharmacological agents in the treatment of patients with chronic anal fissures, a growing concern is developing about their use. Increasing incidence of adverse effects and decreasing long-term efficacy have been the major drawbacks.


CONCLUSIONS
Surgery still remains the preferred option which should be offered to patients with relapse or therapeutic failure with prior pharmacological treatment. Nevertheless, the patient should be informed about the pros and cons of each mode of treatment with details of cure rates and possible complications.
Gupta
Pravin J
PJ
Gupta Nursing Home, D/9, Laxminagar, Nagpur--440022, India. drpjg_ngp@sancharnet.in
D000208:Acute Disease; D000284:Administration, Oral; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D001494:Baths; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D002908:Chronic Disease; D003452:Cryosurgery; D004724:Endoscopy; D005260:Female; D005401:Fissure in Ano / Q000145:classification / Q000188:drug therapy / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007217:Indoramin / Q000008:administration & dosage / Q000627:therapeutic use; D007258:Informed Consent; D053685:Laser Therapy; D008297:Male; D009543:Nifedipine / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications; D011247:Pregnancy; D012008:Recurrence; D013524:Surgical Flaps; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use
D000317:Adrenergic alpha-Antagonists; D000700:Analgesics; D000779:Anesthetics, Local; D014665:Vasodilator Agents; D007217:Indoramin; D019274:Botulinum Toxins, Type A; D009543:Nifedipine