Treatment of anal fissure

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7411.354 (Published 14 August 2003) Cite this as: BMJ 2003;327:354
  1. Richard L Nelson, professor (altohorn@uic.edu)
  1. Division of Colon and Rectal Surgery, University of Illinois College of Medicine at Chicago, 1740 West Taylor, Room 2204, Chicago, Illinois 60612, USA

    Medical treatments are only marginally better than placebo, but surgery may cause incontinence

    Anal fissure is one of the most common lesions to consider in the differential diagnosis of anal pain. This is an ulcer in the squamous epithelium of the anus located just distal to the mucocutaneous junction and usually in the posterior midline. It typically causes episodic pain that occurs during defecation and for one to two hours afterwards.1 This feature uniquely distinguishes anal fissure from other causes of anal pain such as thrombosed haemorrhoids, abscess, viral ulcers, and others. Atypical fissures may be multiple or off the midline, or be large and irregular. These may be caused by inflammatory bowel disease, local or systemic malignancy, venereal infection, trauma, tuberculosis, or chemotherapy. The cause of the typical or benign fissure is not clear nor are there accepted methods for the prevention of fissures—both fertile areas for research.

    The most consistent finding in typical fissures is spasm of the internal anal sphincter, which is so …

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