scholarly journals New approaches to the treatment of anal fissure

2002 ◽  
Vol 49 (2) ◽  
pp. 73-75 ◽  
Author(s):  
A. Dziki ◽  
R. Trzcinski ◽  
E. Langner ◽  
W. Wronski
Keyword(s):  
Anal Canal ◽  
Anal Fissure ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Age Groups ◽  
Dentate Line ◽  
Main Role ◽  
Office Visits ◽  
Anal Fissures ◽  
Longitudinal Defect

According to Antropoli, pathologies of the anal canal are extremely common. About 30 to 40 percent of the population suffers from proctologic pathologies at least once in their lives. In most cases they are more annoying than dangerous. Anal fissure (AF) was recognized as a clinical entity in 1934 . It is a longitudinal defect of the anal canal mucosa and anoderm extending usually from the dentate line to the external verge of the anal canal. This defect exposes the lower half or even most of the fibres of internal anal sphincter. AF is almost always accompanied by extensive tension of this muscle. Anal fissures affect all age groups but predominantly occur in the 3rd and 4th decades of life (2,8,23). Gathright states that fissure disease causes from 6 to 15% of office visits and 10% of operative procedures in a colorectal practice. The etiology of anal fissure has only been partially explained and remains controversial although spasm of the internal anal sphincter has been recognized to play a main role in the pathogenesis of this disease. Recent studies have cast new light on the pathogenesis of anal fissures.

scholarly journals Utility of Ultrasound in the Evaluation of Chronic Anal Fissure

2020 ◽  
pp. 1-4
Author(s):  
Ashraf Talaat Youssef ◽  
Ashraf Talaat Youssef
Keyword(s):  
Anal Fissure ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Chronic Anal Fissure ◽  
Transvaginal Ultrasound ◽  
Clinical History ◽  
Dentate Line ◽  
Chemical Sphincterotomy ◽  
Healing Response ◽  
Asymptomatic Patients

Introduction: Anal fissure is a linear tear in the anal mucosa seen distal to the dentate line. The diagnosis of chronic anal fissure depends on clinical history, physical exam, anoscopy and other imaging modalities are uncommonly recommended unless an associated condition was suspected. Management is either by chemical sphincterotomy or surgery through lateral internal sphincterotomy when chronic anal fissure was resistant to treatment. Purpose of the Study: The current study aimed to evaluate the sonographic findings that can be observed in cases with chronic anal fissure and their significance. Methodology: 15 asymptomatic patients and 30 patients with chronic anal fissure were examined with 3 dimensional transperineal ultrasound and if females an additional transvaginal ultrasound was performed. Results: 26 patients (86.5%) showed diffusely thickened internal anal sphincter of mean thickness >3.5mm, ranging from 3.7 mm to 6.4mm and the mean value was 5mm. 3 patients (10%) with posterior fissure showed a lucent narrow defect in the internal anal sphincter at the midline of the distal aspect of the anal canal wall. One of them showed associated localized intersphincteric plane sepsis. Conclusion: Use of ultrasound in cases with chronic anal fissure may show gapping of the internal anal sphincter and an associated intersphincteric plane sepsis corresponding to the high morphological grade of anal fissure which predict poor healing response to chemical sphincterotomy and further studies that correlate between the thickness and texture of IAS and the healing response to chemical sphincterotomy recommended.

Anal Fissure in Children

2020 ◽  
Vol 30 (05) ◽  
pp. 391-394
Author(s):  
Barbora Patkova ◽  
Tomas Wester
Keyword(s):  
Anal Canal ◽  
Anal Fissure ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Nonoperative Management ◽  
Botulinum Toxin Injection ◽  
Nonoperative Treatment ◽  
Sphincter Pressure ◽  
First Choice ◽  
Definitive Therapy

AbstractAnal fissure is a common clinical problem in children and is defined as a longitudinal tear in the anal canal. The typical presentation is painful defecation and rectal bleeding. The etiology of anal fissure is unknown, but passage of hard stools and increased internal anal sphincter pressure are considered important factors. The treatment is oriented to relieve the spasm of the internal anal sphincter, which prevents healing of the fissure. Conservative management with stool softeners, topical analgesics, and sitz baths is recommended as first-choice therapy. Surgical treatment has been replaced by nonoperative management as definitive therapy, which is associated with a marginally higher success rate than placebo. Most recent studies have focused on nonoperative treatment with glyceryl trinitrate, calcium channel blockers, or botulinum toxin injection treatment. There are a few controlled studies to compare the different nonoperative treatment options in children. Success rates vary between the studies, and there is no clear evidence about which is the optimal nonoperative treatment. A significant recurrence rate has been reported after nonoperative management of anal fissure. It is important to treat constipation to avoid recurrent tears in the anal canal.

scholarly journals Possibilities of medical relaxation of the internal anal sphincter for anal fissures

2021 ◽  
Vol 18 (2) ◽  
pp. 105-110
Author(s):  
M. V. Abritsova ◽  
N. R. Torchua ◽  
E. M. Bogdanova ◽  
M. A. Markina
Keyword(s):  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Anal Fissures

scholarly journals Towards Safer Treatments for Benign Anorectal Disease: The Pharmacological Manipulation of the Internal Anal Sphincter

2007 ◽  
Vol 89 (6) ◽  
pp. 574-579 ◽  
Author(s):  
Oliver M Jones
Keyword(s):  
Clinical Trials ◽  
Animal Models ◽  
Anal Fissure ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Small Scale ◽  
Organ Bath ◽  
Vitro Analysis ◽  
In Vitro Analysis

INTRODUCTION The internal anal sphincter (IAS) is an important structure that is responsible for the majority of resting tone of the sphincter complex. It has a central role in continence and damage to the muscle has serious implications. Injury is most frequently from obstetric trauma though iatrogenic injury from proctological surgery is also common. This review expands on how developments in understanding of the pharmacology of IAS might identify drug treatments as alternatives for proctological conditions such as anal fissure, avoiding the risk of sphincter injury. It also examines the role of pharmacology in treatment of those patients with established incontinence. RESULTS Much of the basic physiology and pharmacology of the IAS has been established through in vitro analysis, particularly in the superfusion organ bath. Further analysis has been undertaken using animal models such the pig. Clinical trials have established the efficacy of a number of agents for reducing IAS tone including glyceryl trinitrate and botulinum toxin. These drugs are probably safer, but less effective, than surgery for sphincter spasm, as is seen in anal fissure, though surgery alone or in combination with drug treatment may be appropriate for some patients. In vitro analysis and small-scale clinical trials suggest that phenylephrine and methoxamine may have a role in treating patients with incontinence primarily attributable to inadequate IAS function. CONCLUSIONS The pharmacology of IAS has been extensively studied in the laboratory, both in vitro and in animal models. In a short time, this laboratory work has been applied to clinical problems after testing in clinical trials. It is likely, however, that the best drugs and the optimal targets for manipulation have not yet been identified.

Extent of division of the internal anal sphincter in chronic anal fissure

2016 ◽  
Vol 29 (3) ◽  
pp. 570
Author(s):  
AhmedS Goda ◽  
SamirM. H. Kohla ◽  
Ahmed Fawzy
Keyword(s):  
Anal Fissure ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Chronic Anal Fissure

A Comparative Study of Structure and Function of the Longitudinal Muscle of the Anal Canal and the Internal Anal Sphincter in Pigs

2009 ◽  
Vol 52 (11) ◽  
pp. 1902-1911 ◽  
Author(s):  
Alvaro Opazo ◽  
Begoña Lecea ◽  
Carme Admella ◽  
Maria José Fantova ◽  
Marcel Jiménez ◽  
...  
Keyword(s):  
Comparative Study ◽  
Anal Canal ◽  
Anal Sphincter ◽  
Internal Anal Sphincter ◽  
Longitudinal Muscle ◽  
Structure And Function ◽  
And Function

scholarly journals Manometric Evaluation of Internal Anal Sphincter after Fissurectomy and Anoplasty for Chronic Anal Fissure: A Prospective Study

2012 ◽  
Vol 78 (5) ◽  
pp. 523-527 ◽  
Author(s):  
Rosalia Patti ◽  
Valentina Territo ◽  
Paolo Aiello ◽  
Giuseppe Livio Angelo ◽  
Gaetano Di Vita
Keyword(s):  
Postoperative Complications ◽  
Anal Fissure ◽  
Anal Sphincter ◽  
Anal Incontinence ◽  
Internal Anal Sphincter ◽  
Healthy Subjects ◽  
Chronic Anal Fissure ◽  
Skin Flap ◽  
Anal Continence ◽  
Squeeze Pressure

Chronic anal fissure (CAF) is a common painful clinical disease and its pathogenesis remains poorly understood. After failure of pharmacological therapy, that is the first-line treatment, surgical sphincterotomy remains the treatment of choice although it is followed by a high rate of anal incontinence resulting from the sphincter damage; therefore, the research of a sphincter-saving surgical option has become an important goal. The aim of this study was to evaluate the manometric modifications and the incidence of anal incontinence after fissurectomy and anoplasty with advancement skin flap in patients affected by CAF with hypertonia of the internal anal sphincter (IAS). Fifteen patients affected by CAF with hypertonia of IAS, unresponsive to medical therapy, were enrolled. All subjects underwent fissurectomy and anoplasty with advancement skin flap. Anorectal manometry was performed preoperatively and after 6 and 12 months from surgery. Maximum resting pressure (MRP), maximum squeeze pressure (MSP), ultraslow wave activity (USWA), fissure healing, anal continence, and postoperative complications were recorded. All patients healed within 30 days from surgery. No intra- or postoperative complications were recorded except for a case of partial donor site break. No significant modifications of MSP were detected. Six months after surgery, MRP was higher with respect to healthy subjects but significantly reduced in comparison to baseline levels. At 12 months, it was higher have versus 6-month values but significantly lower versus preoperative values. USWA was significantly represented in patients with CAF versus healthy subject. Both at 6 and 12 months, they decreased significantly with respect to preoperative values without significant differences versus healthy subjects. Both at 6 and 12 months, anal continence did not differ with respect to preoperative time. The fissurectomy with anoplasty resulted in a high healing rate without surgical sequelae or anal incontinence. Also, it was able to reduce IAS pressure in the same manner as surgical sphincterotomy or forceful dilatation.

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