title: Low energy manual anal stretch: an approach in the treatment of chronic anal fissure.
abstract: BACKGROUND
  Anal fissure is a tear in the epitelial lining of the anal canal. This is a very common anorectal disorder, but the choice of treatment is unclear. Sphincterotomy is effective but it is affected by a high risk of fecal incontinence. Manual anal stretch is aN efficacious, economic and safe maneuver. The aim of this prospective study was to assess the safety and effectiveness of anal stretch in resolving chronic anal fissures.
  
  
  METHODS
  Twenty-five patients with a clinical diagnosis of chronic anal fissure were submitted to anal stretch. All patients were submitted to anal stretch, after clinical evaluation. All patients were studied at basal time, and at 7 days, 3, 6 and 12 months after the treatment.
  
  
  RESULTS
  At 3 months and 6 months after the anal stretch, 88% and 94% of patients showed a resolution of anal fissures and only 12% have relapsed at 12 months, without complications, such as faecal incontinence.
  
  
  CONCLUSIONS
  The anal stretch appears to induce better resolution of chronic anal fissure with a very low risk of fecal incontinence.
authors.affiliation: Department of General Surgery and Organ Transplantation, &quot;Paride Stefanini&quot; Institute, Policlinico Umberto I, Sapienza University, Rome, Italy - fagaj@tin.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Gaj
authors.affiliation: Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Ivano
authors.initials: I
authors.lastname: Biviano
authors.affiliation: Department of Internal Medicine and Medical Specialties, Policlinico Umberto I, Sapienza University, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Candeloro
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004106:Dilatation / Q000009:adverse effects / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005401:Fissure in Ano / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D026201:Musculoskeletal Manipulations / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D064232:Visual Analog Scale; D055815:Young Adult