The Evolution of the Treatment of Anal Fissure in the United States - A Review

Herand Abcarian, Ariane M. Abcarian


Anal fissure is a common anal disease with typical severe post defection pain and minimal bleeding.  Majority of fissures (98%) occur in posterior midline and the rest anteriorly.  Correct diagnosis is important to avoid treating patients erroneously as having hemorrhoids.  Nitroglycerine ointment (GTN) and calcium channel blockers (CCB) will results in healing in 50% of the patients but recurrences are common after discontinuing the treatment.  Botulinum toxin in randomized trials, has not proven to be superior to GTN or CCB.  Lateral internal sphincterotomy is the procedure of choice for chronic anal fissure and the incidence of postsurgical fecal incontinence is small.


Anal Fissure, Internal Sphincter, Nitroglycerine; Calcium Channel Blockers, Botulinum Toxin, Lateral Internal Sphincterotomy

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