Abstract
Background: Anal fissure is a painful condition characterized by a persistent tear in the epidermal lining of the anus. Patients with acute anorectal problem should be handled with a careful clinical assessment since many of them are suffering from pain, discomfort and embarrassment. The guidelines recommend initial nonsurgical management, which results in resolution of the anal fissure in the majority of patients. Unfortunately, a significant proportion of patients will fail conservative management and require further treatment.
Objective
To review the different approaches of anal fissure treatment mentioned and discussed in the recent literature.
Method
PubMed database were used for articles selection. All relevant articles related to our review were chosen to cover the following topics: Anal Fissure, Management, Diagnosis and Outcomes. We excluded other articles, which are not related to our objectives. The data have been extracted according to specific form to be reviewed by the authors.
Conclusion
The goals of management are to break the cycle of anal sphincter spasm allowing improved blood flow to the fissured area so that healing can occur. Almost half of patients with acute anal fissures will heal with conservative measures alone such as increased fiber intake and sitz baths. Pharmacological sphincterotomy can be achieved by use calcium channel blockers, or injections of botulinum toxin into the sphincter but pharmacological relaxation of the sphincter does not always lead to rapid and persistent healing of chronic anal fissures. However, the search for the perfect nonsurgical treatment will continue. Lateral internal sphincterotomy remains the gold standard surgical treatment for chronic anal fissures of all other surgical interventions. Nevertheless, recent papers advice for judicious sphincterotomy in order to minimize the risk of incontinence.