Chronic anal fissure

Abstract

Today, chronic anal fissure can be treated and often cured by nonsurgical therapy. Both topical application of glyceryl tri nitrate and intra-sphincteric injection of botulinum toxin appear to be safe and effective in relieving symptoms and in healing the anal fissure in 70% to 90% of patients. These drugs should now be regarded as the mainstay of therapy for chronic fissure-in-ano. Surgery should only be performed in refractory cases and should no longer be the first-line approach, largely because of the unpredictable and unacceptable adverse effects. It is important to emphasize that although the aforementioned therapies can heal fissure-in-ano, simpler lifestyle measures may be effective in the majority of patients with acute anal fissure. These include avoiding excessive straining, consuming a high fiber diet, using stool softeners, and taking warm sitz baths, together with local emollients with or without local anesthetics and steroids.