![]() Longer internal anal sphincter division (to the dentate line, as opposed to the fissure apex only) may be more effective at reducing anal fissure. Open partial lateral internal anal sphincterotomy may be equivalent to closed partial internal anal sphincterotomy in fissure healing. We do not know whether internal anal sphincterotomy is better or worse than anal advancement flap in improving fissure healing. They are among the most common causes of anal pathology, and subsequently are blamed for virtually any anorectal complaint by patients and medical professionals alike. The pain typically occurs with or shortly after defecation, lasts for several hours, and subsides until the next bowel movement. We do not know whether anal dilation is more effective than topical nitroglycerin at reducing the proportion of persons with anal fissure. Hemorrhoids are swollen blood vessels in the lower rectum. An external skin tag (the sentinel pile) may be present at the lower end of the fissure, and an enlarged (hypertrophic) papilla may be present at the upper end. One small randomized controlled trial found limited evidence that controlled anal dilation may be equivalent to sphincterotomy in fissure healing, with negligible incontinence risk. Internal anal sphincterotomy also increases fissure healing compared with digital anal stretch, and anal stretch is more likely to cause flatus incontinence. It improves fissure healing compared with treatment with nitric oxide donors (topical nitroglycerin, topical isosorbide dinitrate), botulinum A toxin–hemagglutinin complex, and calcium channel blockers (nifedipine, diltiazem). A physical examination confirms the suspicion of anal fissure and rules out other pathology. ![]() Anal fissure diagnosis is usually straightforward and can often be made on the patients history alone. Internal anal sphincterotomy is more effective than medical therapy for chronic anal fissure in adults. Untreated fissures develop a hood-like skin tag (sentinel piles) which cover the fissure and cause discomfort and pain. Some patients may have a tender sentinel pile and often these patients feel the pile is the source of their pain. The cause is not fully understood, but low intake of dietary fiber may be a risk factor.Ĭhronic fissures typically have a cyclical history of intermittent healing and recurrence, but about 35% will eventually heal, at least temporarily, without intervention.Ītypical features, such as multiple, large, or irregular fissures, or those not in the midline, may indicate underlying malignancy, sexually transmitted infections, inflammatory bowel disease, or trauma. Anal fissures are a common cause of anal pain during and for one to two hours after defecation.
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