Treating anal fissureBMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7095.1638 (Published 07 June 1997) Cite this as: BMJ 1997;314:1638
Glyceryl trinitrate ointment may remove the need for surgery
- Anjan K Banerjee, Consultant surgeona
- a Colorectal Unit, Royal Halifax Infirmary, Halifax HX1 2YP
Patients with chronic anal fissures make up about 10% of new attenders at colorectal outpatient clinics. The cause is known: traumatic or ischaemic damage to the anal mucosa produces a superficial tear, usually in the posterior midline. Subsequent spasm of the internal sphincter leads to the lesion becoming chronic. The clinical hallmarks are an external hypertrophic skin tag or “sentinel pile” and induration in the base.
In the past the surgical treatment was manual dilatation of the anus under a general anaesthetic, but this resulted in high rates of long term incontinence and recurrence. The surgical approach was, therefore, changed to a lateral anal sphincterotomy, but this was associated with incontinence (about 20-30% of patients were incontinent of flatus, 5-10% had soiling, and 2-5% had faecal incontinence), and a long term failure rate of about 5%.1
Clearly, a new treatment was needed, and …