A review of chronic anal fissure management.
Anal fissure management has rapidly progressed in the last 15 years as our understanding of fissure pathophysiology has developed. All methods of treatment aim to reduce the anal sphincter spasm associated with chronic anal fissures. Surgical techniques have been used for over 100 years with success. Lateral internal sphincterotomy remains the surgical treatment of choice for many practitioners. Postoperative impairment of continence remains controversial. Recently, less invasive methods of treatment have been explored. Topical nitrates, calcium channel blockers and botulinum toxin are established treatments. These and other non-surgical treatments are described in this review. Various guidelines and treatment algorithms for anal fissure are also discussed.
Collins
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Department of Surgery, University of Nottingham Medical School, Derby, Derby City General Hospital, Uttoxeter Road, Derby, DE22 3DT, UK. emma.collins@nottingham.ac.uk
Lund
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D000287:Administration, Topical; D000465:Algorithms; D001905:Botulinum Toxins / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002908:Chronic Disease; D013505:Digestive System Surgical Procedures / Q000379:methods; D004106:Dilatation / Q000379:methods; D005242:Fecal Incontinence / Q000209:etiology; D005401:Fissure in Ano / Q000628:therapy*; D006801:Humans; D009465:Neuromuscular Agents / Q000627:therapeutic use; D020030:Nitric Oxide Donors / Q000627:therapeutic use; D011183:Postoperative Complications
D002121:Calcium Channel Blockers; D009465:Neuromuscular Agents; D020030:Nitric Oxide Donors; D001905:Botulinum Toxins