Download PDF
Clin Colon Rectal Surg 2001; 14(3): 193-202
DOI: 10.1055/s-2001-16547
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Anal Fissures

K. Steven Wiley1 , Bertram T. Chinn2
  • 1Department of Colon and Rectal Surgery, University of Medicine and Dentistry of New Jersey-RW Johnson University Hospital, New Brunswick, NJ
  • 2Department of Surgery, University of Medicine and Dentistry of New Jersey-RW Johnson University Hospital, New Brunswick, NJ, and Muhlenberg Regional Medical Center, Plainfield, NJ
Further Information

Publication History

Publication Date:
22 August 2001 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Anal fissures are a frequent anorectal problem that commonly affects the young and middle aged. Men and women are equally affected, with the posterior area more frequently involved than the anterior. Pain associated with the fissure is more severe than the wound would suggest. Many fissures respond to nonoperative management. Fissures, which fail to heal with nonoperative measures, generally require a partial lateral internal sphincterotomy. In those with compromised sphincter function, an anal-mucosal advancement flap is recommended.

KEYWORD

Anal fissure - internal sphincter - sphincterotomy - nitroglycerin - botulinum

REFERENCES

  • 1 Gordon P H. Fissure-in-ano. In: Gordon PH, Nivatvongs S, eds. Principles and Practice of Surgery for the Colon, Rectum and Anus St. Louis, Mo: Quality Medical Publishing 1999: 217-240
    Search in Google Scholar
  • 2 Lund J N, Scholefield J H. Aetiology and treatment of anal fissure.  Br J Surg . 1996;  83 1335-1344
    CrossrefPubMedSearch in Google Scholar
  • 3 Petros J G, Rimm E B, Robillard R J. Clinical presentation of chronic anal fissures.  Am Surg . 1993;  59 666-668
    PubMedSearch in Google Scholar
  • 4 Oh C, Divino C M, Steinhagen R M. Anal fissure: 20-year experience.  Dis Colon Rectum . 1995;  38 378-382
    CrossrefPubMedSearch in Google Scholar
  • 5 Notaras M J. Anal fissure and stenosis.  Surg Clin North Am . 1988;  68 1427-1440
    PubMedSearch in Google Scholar
  • 6 Rosen L, Abel M E, Gordon P H. Practice parameters for the management of anal fissure.  Dis Colon Rectum . 1992;  35 206-208
    PubMedSearch in Google Scholar
  • 7 Nothmann B J, Schuster M M. Internal anal sphincter derangement with anal fissures.  Gastroenterology . 1974;  67 216-220
    PubMedSearch in Google Scholar
  • 8 Prohm P, Bonner C. Is manometry essential for surgery of chronic fissure-in-ano?.  Dis Colon Rectum . 1995;  38 735-738
    PubMedSearch in Google Scholar
  • 9 Schrock T, Cerra F, Hawley P R, Hunt T K, Nichols R L, Samson R B. Symposium: wounds and wound healing.  Dis Colon Rectum . 1982;  25 1-15
    PubMedSearch in Google Scholar
  • 10 Blaisdell P C. Pathogenesis of anal fissure and implications as to treatment.  Surg Gynecol Obstet . 1937;  65 672-677
    PubMedSearch in Google Scholar
  • 11 Schouten W R, Briel J W, Auwerda J JA, Graaf E JR. Ischaemic nature of anal fissure.  Br J Surg . 1996;  83 63-65
    CrossrefPubMedSearch in Google Scholar
  • 12 Klasterhalfen B, Vogel P, Rixen H, Mittermayer C. Topography of the inferior rectal artery: a possible cause of chronic, primary anal fissure.  Dis Colon Rectum . 1989;  32 43-52
    PubMedSearch in Google Scholar
  • 13 Schouten W R, Briel J W, Auwerda J JA. Relationship between anal pressure and anodermal blood flow: the vascular pathogenesis of anal fissures.  Dis Colon Rectum . 1994;  37 664-669
    CrossrefPubMedSearch in Google Scholar
  • 14 Shub H A, Salvati E P, Rubin R J. Conservative treatment of anal fissure. An unselected, retrospective and continuous study.  Dis Colon Rectum . 1978;  21 582-583
    CrossrefPubMedSearch in Google Scholar
  • 15 Hananel N, Gordon P H. Lateral internal sphincterotomy revisited.  Dis Colon Rectum . 1997;  40 597-602
    PubMedSearch in Google Scholar
  • 16 Hyman N H, Cataldo P A. Nitroglycerin ointment for anal fissures: effective treatment or just a headache?.  Dis Colon Rectum . 1999;  42 383-385
    CrossrefPubMedSearch in Google Scholar
  • 17 Dorfman G, Levitt M, Platell C. Treatment of chronic anal fissure with topical glyceryl trinitrate.  Dis Colon Rectum . 1999;  42 1007-1010
    CrossrefPubMedSearch in Google Scholar
  • 18 Manookian C M, Fleshner P, Moore B, Teng F, Cooperman H, Sokol T. Topical nitroglycerin in management of anal fissure: an explosive outcome! Am Surg .  1998;  64 962-964
    PubMedSearch in Google Scholar
  • 19 Gorfine S R. Treatment of benign anal disease with topical nitroglycerin.  Dis Colon Rectum . 1995;  38 453-457
    CrossrefPubMedSearch in Google Scholar
  • 20 Watson S J, Kamm M A, Nicholls R J, Phillips R K. Topical glyceryl trinitrate in the treatment of chronic anal fissure.  Br J Surg . 1996;  83 771-775
    PubMedSearch in Google Scholar
  • 21 O'Kelly T, Brading A, Mortensen N. Nerve mediated relaxation of the human sphincter: the role of nitric oxide.  Gut . 1993;  34 689-693
    PubMedSearch in Google Scholar
  • 22 Brisinda G, Maria G, Betivoglio A R. A comparison of injections of botulinum toxin and topical nitroglycerin ointment for the treatment of chronic anal fissure.  N Engl Med . 1999;  341 65-69
    CrossrefPubMedSearch in Google Scholar
  • 23 Richard CS,Gregoire R, Plewes E A. Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure.  Dis Colon Rectum . 2000;  43 1048-1058
    PubMedSearch in Google Scholar
  • 24 Jost W H. One hundred cases of anal fissure treated with botulin toxin: early and long-term results.  Dis Colon Rectum . 1997;  40 1029-1032
    CrossrefPubMedSearch in Google Scholar
  • 25 Minguez M, Melo F, Espi A. Therapeutic effects of different doses of botulinum toxin in chronic anal fissure.  Dis Colon Rectum . 1999;  42 1016-1021
    PubMedSearch in Google Scholar
  • 26 Triggle D J. Calcium, calcium channels, and calcium channel antagonists.  Can J Physiol Pharmacol . 1990;  68 1474-1481
    PubMedSearch in Google Scholar
  • 27 Katoh N. Calcium channel blockers suppress the contact hypersensitivity reaction (CHR) by inhibiting antigen transport and presentation by epidermal Langerhans cells in mice.  Clin Exp Immunol . 1997;  108 302-308
    CrossrefPubMedSearch in Google Scholar
  • 28 Antropoli, et al. Nifedipine for local use in conservative treatment of anal fissures: preliminary results of a multicenter study.  Dis Colon Rectum . 1999;  42 1011-1015
    PubMedSearch in Google Scholar
  • 29 Carapeti E A, Kamm M A, Phillips R K. Topical diltiazem and bethanechol decrease anal sphincter pressure and heal anal fissures without side effects.  Dis Colon Rectum . 2000;  43 1359-1362
    CrossrefPubMedSearch in Google Scholar
  • 30 Lord P H. Diverse methods of managing hemorrhoids: dilation.  Dis Colon Rectum . 1973;  16 180-183
    PubMedSearch in Google Scholar
  • 31 Goldman G, Zilberman M, Werbin N. Bacteremia in anal dilation.  Dis Colon Rectum . 1986;  29 304
    PubMedSearch in Google Scholar
  • 32 Hawley P R. The treatment of chronic fissure-in-ano: a trial of methods.  Br J Surg . 1969;  56 915-918
    PubMedSearch in Google Scholar
  • 33 Magee H, Thompson H. Internal anal sphincterotomy as an outpatient operation.  Gut . 1966;  7 190-192
    PubMedSearch in Google Scholar
  • 34 Eisenhammer S. Surgical correction of chronic internal anal (sphincteric) contracture.  S Afr Med J . 1951;  25 486
    PubMedSearch in Google Scholar
  • 35 Pernikoff B J, Eisenstat T E, Rubin R J. Reappraisal of partial lateral internal sphincterotomy.  Dis Colon Rectum . 1994;  37 1291-1295
    PubMedSearch in Google Scholar
  • 36 Nyam D N K C, Pemberton J H. Long term results of lateral internal sphincterotomy for chronic anal fissure with particular reference to incidence of fecal incontinence.  Dis Colon Rectum . 1999;  42 1306-1310
    PubMedSearch in Google Scholar
  • 37 Hoffman D, Goligher J. Lateral subcutaneous internal sphincterotomy in treatment of anal fissure.  Br Med J . 1970;  3 673-675
    PubMedSearch in Google Scholar
  • 38 Abcarian H A. Surgical correction of chronic anal fissure: results of lateral internal sphincterotomy vs fissurectomy-midline sphincterotomy.  Dis Colon Rectum . 1980;  23 31-36
    CrossrefPubMedSearch in Google Scholar
  • 39 Walker W A, Rothenberger D A, Goldberg S M. Morbidity of internal sphincterotomy for anal fissure and stenosis.  Dis Colon Rectum . 1985;  28 832-835
    PubMedSearch in Google Scholar
  • 40 Khubchandani I T, Reed J F. Sequelae of internal sphincterotomy for chronic fissure in ano.  Br J Surg . 1989;  76 431-434
    PubMedSearch in Google Scholar
  • 41 Argov S, Levandovsky O. Open lateral sphincterotomy is still the best treatment for chronic anal fissure.  Am J Surg . 2000;  179 201-202
    CrossrefPubMedSearch in Google Scholar
  • 42 Notaras M. Lateral subcutaneous sphincterotomy for anal fissure: a new technique.  Proc R Soc Med . 1969;  62 713
    PubMedSearch in Google Scholar