Anal Fissure

General measures (conservative approach)

• An acute fissure is typically managed with non-operative treatments and over 90% will heal without surgery. Often treating constipation or diarrhea can cure a fissure

• High fiber diet, bulking agents, stool softeners, and plenty of fluids help relieve constipation, promote soft bowel movements, and help in the healing process. Increased dietary fiber may also help to improve diarrhea.

• Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles, which can also help healing.

• Use of moist tissues or shower spray is often better alternative to toilet paper after bowel movements. – See more at: http://neoalta.com/anal-fissure#sthash.J4FKs6E0.dpuf

• Simple hygiene practices like washing the perineum and padding dry is recommended

• Sitz Baths – Sitting in a tub filled with lukewarm water with or without 2 tablespoonfuls of salt provide comfort by relaxing the anal tone and relieving the pain.

• Topical anesthetics such as 2% lignocaine may be recommended.

• Topical Nitrates Application around the perianal skin 2 to 3 times a day is shown to improve the local blood flow and reduce the pressure exerted by the internal anal sphincter, thereby increasing the chances of healing.

• Topical Calcium Channel Blockers These act mainly by reducing the internal anal sphincter pressure.

• Botox Injection of botulinum toxin into the internal anal sphincter (‘chemical sphincterotomy’) results in reduction of the internal anal sphincter pressure. Effect lasts for 2-3 months, allowing the fissure to heal

• Surgery is a highly effective treatment for chronic fissure and recurrence rates after surgery are low.

• Surgery usually consists of a small operation to cut a portion of the internal anal sphincter muscle. This helps the fissure heal and decreases pain and spasm.

• If a sentinel pile is present, it may be removed to promote healing of the fissure.

• Botox Injection of botulinum toxin into the internal anal sphincter (‘chemical sphincterotomy’) results in reduction of the internal anal sphincter pressure. Effect lasts for 2-3 months, allowing the fissure to heal.

• Anal fissures are associated with pain. Bleeding from piles is usually painless.

• Most acute fissures heal with conservative measures.

• General measures- fluid intake, ensuring soft consistency of stools and symptomatic relief with topical anesthetics and analgesics.

• Medical therapy is a good option for acute fissures although the efficacy and complication rates are variable.

• Most patients with chronic anal fissures will require surgical treatment, which have excellent results. These are routinely performed in a day surgery setting.

• Recurrent fissures should be evaluated by an experienced coloproctologist with adjunct investigations such as anal manometry and endoanal ultrasonography before deciding on the appropriate therapy.

• A typically located fissures must be biopsied to rule out certain severe diseases.