Management Of Anal Fissure Research Articles

Temporal trends and treatment patterns in anal fissure management: insights from a multicenter study in Italy

IntroductionAnal fissure (AF) poses a common challenge in clinical practice, prompting various treatment approaches. This multicenter study, conducted by the Italian Society of Colorectal Surgery, aimed to assess treatment trends in AF over a 10 year period.MethodsA survey of proctologists and retrospective analysis of patient records were conducted to evaluate treatment modalities and outcomes across six different clinical scenarios based on AF presentation (acute/chronic) stratified by sphincter function (normal/hypertonic/hypotonic).ResultsAnalysis of data from 17 principal investigators and 22,016 patients revealed significant variability in treatment approaches, influenced by factors such as symptom duration, anal tone, and surgeon preference. Conservative treatments were commonly utilized, while surgical interventions were reserved for refractory cases. Specifically, pharmaceutical treatment was administered to 66–75% of patients in cases of acute AF and 63–67% for chronic AF, while 10–15% underwent anal dilation, and < 2% received botulinum toxin injection. Among medical treatments, nifedipine with lidocaine and glycerin film-forming ointments were the most utilized. The most performed surgical techniques were fissurectomy and anoplasty, except for patients with chronic AF and hypertonic sphincter where sphincterotomy prevailed. Trends in treatment utilization varied depending on the clinical scenario, with notable shifts observed over time.ConclusionsThis study provides insights into the evolving landscape of AF management, highlighting the need for further research to elucidate optimal treatment strategies and improve patient outcomes.

Belgian consensus guideline on the management of anal fissures.

Acute and chronic anal fissures are common proctological problems that lead to relatively high morbidity and frequent contacts with health care professionals. Multiple treatment options, both topical and surgical, are available, therefore evidence-based guidance is preferred. A Delphi consensus process was used to review the literature and create relevant statements on the treatment of anal fissures. These statements were discussed and modulated until sufficient agreement was reached. These guidelines were based on the published literature up to January 2023. Anal fissures occur equally in both sexes, mostly between the second and fourth decades of life. Diagnosis can be made based on cardinal symptoms and clinical examination. In case of insufficient relief with conservative treatment options, pharmacological sphincter relaxation is preferred. After 6-8 weeks of topical treatment, surgical options can be explored. Both lateral internal sphincterotomy as well as fissurectomy are well-established surgical techniques, both with specific benefits and risks. The current guidelines for the management of anal fissures include recommendations for the clinical evaluation of anal fissures, and their conservative, topical and surgical management.

COMPARISON OF EFFECTIVENESS OF TOPICAL NIFEDIPINE AND DILTIAZEM IN THE TREATMENT OF ANAL FISSURES

Anal fissure, a tear in the anal canal below the dentate line, is commonly managed pharmacologically as the primary approach, with surgery considered secondary. Objective: To compare the efficacy of topical nifedipine and diltiazem in the prompt resolution of pain and bleeding associated with anal fissure management. Methods: A prospective cohort study was conducted at Dr. Ruth K. M. Pfau Civil Hospital, Karachi, from June 2023 to November 2023. One hundred patients with anal fissures were randomly allocated into two groups: Group N (Nifedipine) and Group D (Diltiazem). Topical medication was administered until healing occurred. The visual analogue scale (VAS) assessed the patient's progress in terms of bleeding and pain. Side effects were monitored. Statistical analysis included an independent t-test for comparing VAS scores and a post-stratification chi-square test for associations between bleeding, side effects, and other variables. Results: At baseline, mean pain scores were 8.30±0.90 in group D and 7.78±1.29 in group N. At the first follow-up, mean pain scores were 5.58±1.34 in group D and 4.56±1.48 in group N, with a significant difference (p&lt;0.001). Bleeding did not significantly decrease at the first follow-up but decreased significantly at the subsequent follow-ups in both groups. Side effects did not differ significantly between groups. Conclusion: Topical nifedipine is more effective than diltiazem for managing anal fissures in terms of pain reduction. However, both medications showed comparable efficacy in reducing bleeding, with no significant difference in side effects observed.

Anal Fissure: Clinical Practice, Diagnosis in Primary Care and Management Guideline. A Literature Reviews

ABSTRACT&#x0D; &#x0D; Anal fissures or tears in the anus are very common. At least 1 in 350 people have experienced an anal fissure. About 20% of anal fissures are accompanied by hemorrhoids. However, there are still few patients or sufferers of anal fissure who know about this condition. Not many doctors or health workers are aware of how to diagnose to primarytreatment or treatment of anal fissures, so patients with anal fissures are often referred directly for surgery. In fact, anal fissures can be treated without surgery, such as dietary modifications. Surgery also has several indications and needs to be considered regarding post-operative complications that can actually be avoided. This article discusses the clinicalmanifestations, diagnosis and management of anal fissures.&#x0D; Keyword: anal fissure, clinical practice, primary care, management.

Treatment Non-Compliance due to Glyceryl Trinitrate Side Effects in Anal Fissure

Objective: Anal fissures generally respond very well to the glyceryl trinitrate (GTN) ointment. However, it is associated with side effects like headache and hypotension. The objective was to evaluate the noncompliance of patients with topical glyceryl trinitrate due to its side effect in the management of anal fissure. &#x0D; Methodology: After taking ethical approval, a prospective case series was conducted at IIMCT-Pakistan Railway Hospital over a period from 1st March, 2023 to 31st August 2023. A sample size of 112 was calculated using WHO calculator 1.1 and these many patients were subsequently studied for side-effects of GTN and their compliance to the therapeutic regime.&#x0D; Results: Of 122 patients studied: 62 (55.4%) were males, mean age was 35.35±10.22 years and mean daily doses of GTN was 2.31±0.56. Sixty-five (53%) of the patients using topical GTN reported side effects. Headache and postural hypotension were the most commonly reported side effects: 29.5% and 21.4% reported these side effects, respectively. Non-compliance was noted in only 14 patients (12.5%). Headache contributed 78.6% whereas postural hypotension &amp; palpations contributed 21.4% towards the non-compliant cases. Thus, these two side effects were the only ones contributing towards non-compliance and had statistically highly significant association with non-compliance at a p value of 0.001. 94% of the compliant patient completely healed completely whereas only 2% of non-compliant patients achieved healing till 3-month follow-up: these results were significant at p&lt;0.001. &#x0D; Conclusion: Headache postural hypotension are significant side-effects of GTN; and they lead to non-compliance and thus subsequent failure to achieve healing.

Efficacy of local metronidazole with glyceryl trinitrate versus topical glyceryl trinitrate alone in the treatment of acute anal fissure: a randomized clinical trial

Introduction Anal fissure is one of the most common diseases of the anorectal region that is frequently encountered in surgical practice, equally affects both women and men. Acute anal fissures last shorter than 6 weeks. The American Society of Colon and Rectal Surgeons favors conservative management of anal fissure as the first line of treatment. A rectal ointment containing 0.2% glyceryl triturate (GTN) can be recommended to promote the healing of anal fissures and decreasing sphincter spasm. Metronidazole is a 5-nitroimidazole derivative antibiotic with a cytotoxic bactericidal effect particularly on anaerobic bacteria. The purpose of the present study was to investigate whether local metronidazole antibiotic cream is effective and safe to use in reducing the symptoms and improving the healing process of acute anal fissure. Patients and methods This study was performed in Mansoura University Hospital, surgery outpatient clinic from the period of July 2022 till July 2023. This study was a single-blinded, randomized controlled trial. Total 100 patients were included in this study and randomly divided into two groups, 50 patients in each group. First group (group 1) treated by combination of local metronidazole 10% with 0.2% GTN while the second group treated only with GTN. Results Anal pain were present in both group in all patients with acute anal fissure while constipation were 88% in group 1 and 76% group 2. To lesser extent itching, bleeding, and diarrhea were presented in both group. Visual analog scale for pain intensity were equal in both groups at the time of first clinical examination. After 1 week and 1 month of treatment there were statistically significant difference between both groups thus the visual analog scale were lower in group 1 than group 2 (0.001 and &lt;0.001, respectively). Healing of acute anal fissure was assessed clinically at variable interval for all patients there is statistically significant difference between both group (0.004) as regard healing, first group showed earlier and faster healing and fewer number of nonhealing of the fissure at the end of follow up. Conclusion Adding local metronidazole 10% to the classic GTN treatment will improve the symptoms of acute anal fissure specially pain and discomfort and markedly accelerate healing process.

A randomized controlled clinical study to evaluate the efficacy of Yastimadhu Hydrogel in Parikartika vis-a-vis Fissure-in-Ano

Parikartika, commonly known as Fissure-in-Ano, ranks among the prevalent anorectal disorders and represents a painful affliction affecting the anal region. Its clinical presentation bears a striking resemblance to the description of Parikartika in Ayurvedic texts. Contemporary therapeutic approaches involve the application of local soothing agents, oral analgesics, and stool softeners during the initial stages. Surgical interventions, including Lord’s dilation, fissurectomy, and sphincterotomy, are considered in more advanced cases. Ayurveda, on the other hand, advocates the use of various drugs with distinct properties for treating this condition, with Yashtimadhu being recognized for its Vrana Ropan, Mrudukara, Tvak Prasadana, and Pitta-Anila Hara properties. Recognizing the regenerative potential of hydrogels on the skin, our study sought to evaluate and compare the local effects of Yashtimadhu hydrogel and Yashtimadhu Ghrita in the management of Parikartika. A randomized comparative study was conducted involving 60 patients with Fissure-in-Ano, divided into two groups. The trial group (n=30) received Yashtimadhu hydrogel through local application for a period of 3 weeks, while the control group (n=30) underwent treatment with Yashtimadhu Ghrita during the same duration. Assessment of symptoms such as Pain, Bleeding, Constipation, Itching, Discharge, and the size of anal fissure, along with observations on the anal fissure floor and granulation tissue, revealed promising results. Statistical analysis indicated the effectiveness of both Yashtimadhu hydrogel and Yashtimadhu Ghrita in the conservative management of Parikartika. Notably, Yashtimadhu Ghrita emerged as a more potent remedy in the management of anal fissure when compared to Yashtimadhu hydrogel.

The Association of Coloproctology of Great Britain and Ireland guideline on the management of anal fissure.

The management of anal fissure: ACPGBI position statement was written 15 years ago. [KLR Cross etal., Colorectal Dis, 2008]. Our aim was to update the guideline and provide recommendations on the most effective treatment for patients with anal fissures utilising a multidisciplinary, rigorous guideline methodology. The development process consisted of six phases. In phase 1 we defined the scope of the guideline. The patient population included patients with acute and chronic anal fissure. The target group was all practitioners (primary and secondary care) treating patients with fissures and, in addition, healthcare workers and patients who desired information regarding fissure management. In phase 2 we formed a guideline development group (GDG) including a methodologist. In phase 3 review questions were formulated, using a reversed PICO process, starting with possible recommendations based on the GDG's knowledge. In phase 4 a comprehensive literature search focused on existing systematic reviews addressing each review question, supplemented by more recent studies if appropriate. In phase 5 data were extracted from the included papers and checked by the GDG. If indicated, meta-analysis of systematic review data was updated by the GDG. During phase 6 the GDG members decided what recommendations could be made based on the evidence in the literature and strength of the recommendation was assessed using 'grade'. This guideline is divided into two sections: Primary care which includes (i) diagnosis; (ii) basic treatment; (iii) topical treatment; and secondary care which includes (iv) botulinum toxin therapy; (v) surgical intervention and (vi) special situations (including pregnancy and breast-feeding patients, children, receptive anal intercourse and low-pressure fissures). A total of 23 recommendations were formulated. A new term clinically healed was described by the GDG. This guideline provides an up-to-date evidence-based summary of the current knowledge of the management of anal fissure and may serve as a useful guide for clinicians as well as a potential reference for patients.

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure

IntroductionThe aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature.MethodsA panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology.ConclusionsIn patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

Trends in Management of Anal Fissures.

It is unclear how patients with anal fissures are treated in real-world settings, particularly since patients may not see colorectal surgeons. This study describes trends in treatment with medical therapies (calcium-channel blockers [CCBs], nitroglycerin [NTG], and narcotics) and surgical treatments. Cohorts were created within the TriNetX database platform using codes for anal fissures and surgical interventions. Demographics were compared between patients that received surgical intervention within 1year of diagnosis, CCB or NTG within 1year (or preoperatively), or narcotics within 30days or postoperatively vs those who did not. 121,213 patients were included of which 4.0% had surgical intervention. Factors associated with surgical intervention were male sex (OR 1.40), White race (OR 1.17), and Hispanic ethnicity (OR 1.11). Male patients were more likely to undergo sphincterotomy (OR 1.49). Female (OR 1.27), non-Hispanic (OR 1.34), and White patients (OR 1.41) were more likely to have chemodenervation. Regarding nonoperatively managed patients, non-Hispanic (OR .91) and White patients (OR .89) were less likely to receive CCB/NTG. Male (OR 1.21), non-Hispanic (OR 1.08), and Black patients (OR 1.20) were more likely to receive narcotics. Male patients that required surgery were more likely to be prescribed CCB/NTG preoperatively (OR 1.27). Non-Hispanic surgical patients were more likely to receive narcotics (OR 1.84). Male fissure patients were more likely to undergo surgical intervention other than chemodenervation. Differences in the rates of surgery and medical therapy (especially narcotics) between races and ethnicities require exploration to enhance the care of patients with anal fissures.

A review of recent advances in the surgical management of anal fissures

An anal fissure is a rupture or lesion in the anal canal's lining below the mucocutaneous junction or dentate line. It is a painful condition that can last for up to two hours during and after defecation. The present literature review is aimed at outlining the clinical signs and symptoms, etiopathogenesis, clinical evaluation, and surgical management of anal fissures with a brief discussion on laser-assisted surgeries. This literature review has been compiled to revisit the different treatment modalities of anal fissures based on the recent updates in the literature. PubMed and ScienceDirect databases were used for the literature search of this review. Based on the literature review surgical interventions are necessary when the conventional pharmacological treatment fails to cure the disease. There are varying outcomes based on the type of surgery with respect to healing rates, recurrence, and incontinence. However, the outcomes of surgery may vary from patient to patient. Various studies have shown that lateral internal sphincterotomy is currently considered the most effective surgical treatment for anal fissures. Surgeons may choose to use either the closed or open method for this procedure. Using lasers for sphincterotomy can help to minimize bleeding and postoperative pain. Despite numerous clinical practice guidelines and systematic reviews, there is still debate over the ideal anal fissure treatment. Surgical treatments discussed in this review have varying advantages and the surgeon is the right person to decide which procedure is suitable for the patient.

Botulinum Injection and Sphincterotomy for Management of Anal Fissure in Terms of Healing of Anal Fissure: A Randomized Controlled Trial

Aim: To compare the efficacy of botulinum injection with lateral internal sphincterotomydone for management of anal fissure in terms of healing of anal fissure Study design: Randomized controlled trail Setting and duration: Department of General Surgery, K.E. Medical University, Lahore from April, 2019 to Oct, 2019 Methodology: All 350(175 cases in each group) cases meeting inclusion criteria were enrolled through department of Surgery KEMU. Patients were randomly allocated in two groups, group A and B by Lottery method. Patients in group ‘A’ received treatment with 0.5 ml (20 units) Botulinum toxin injection on each side of anal fissure in the internal anal sphincters under direct vision and digital examination at 3 or 9 o’clock position in lithotomy position under strict aseptic measures by single expert surgeon having at least five years’ post fellowship experience. Patients in group ‘B’ underwent lateral internal anal sphincterotomy under general anesthesia by single expert surgeon also having at least five years’ post fellowship experience. Patients were discharged on 1st post operation day on oral antibiotics, analgesics, stool softeners and were advised sitz bath. In both groups, patients were followed up for 2 months. Results: The mean age of all patients was 43.09 ± 10.68 years while the mean age in Group-A was 43.17±10.32 years and in Group-B was 43.02±11.06 years. The efficacy in Group-A was seen in 158(90.3%) while the efficacy was seen in 114(65.1%) of Group-B, the efficacy of treatment was higher in group-A when compared with Group-B, p-value &lt; 0.001. Conclusion: Botulinum toxin injection for the treatment of anal fissure has yielded higher rates of healing than lateral internal sphincterotomy. This suggests that botulinum injection could provide temporary relief from sphincter spasm, allowing for faster fissure healing and improved quality of life, with fewer risks of complications. Keywords: Sphincterotomy, anal fissure, healing of anal fissure, rectal pain, anal pain, anal surgery

Conservative management of anal fissure accompanying constipation in school-age children

An anal fissure is a common problem in children and it refers to a longitudinal tear or an ulcer in the anoderm. The conventional therapy for anal fissures has been warm sitz baths and lthe ocal application of analgesic ointments, stool softeners ,and behavioral therapy as necessary. Simple wound care may often be sufficient for the treatment of anal fissure, but a comprehensive approach is required for accompanying constipation. Between 2015-2022, a total of 263 children suffering from constipation and perianal pain were diagnosed with anal fissure (AF) based on physical examination. Anal fissure and constipation (AFC) questionnaire forms were retrospectively reviewed and results of routine management protocol were assessed which was focused on local wound care and dietary regulation. The ratio of children consuming more than 2-3 cups of packed beverages containing artificial sweeteners, colorants or corn syrup was found 63,89 % (n=167). Daily water consumtion of less than five glasses was 71.1% (n=187). Daily milk consuming was 71,86% (n=189). Stool withholding and soiling was found 57,41% (n=151) and 48,67% (n=128) respectively. In only four cases (1.52%), constipation persisted for more than eight weeks despite meticulous management and improvement was achieved with anal dilatation on the tenth week. It is possible to treat anal fissures successfully and in a reasonable duration with simple local care with prednisolone pomade and a strict diet arrangement that restricts the consumption of packed foods, beverages, snacks, and milk while promoting drinking water and raw fiber intake.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

Non-operative management of anal fissure: success vs failure

Non-operative management of anal fissure: success vs failure

Role of homoeopathy in the management of anal fissure

Anal fissure is one of the most painful anorectal diseases which makes the patient seek medical help. The textbooks of modern medicine classify anal fissures into acute and chronic depending on the duration. The position of the fissure and also other underlying diseases if present, predispose the fissure towards chronicity. According to Hahnemannian classification of diseases, anal fissures are tubercular in origin. Combined with Sycotic miasm, the condition becomes aggravated and difficult to cure. Homoeopathic medicines like Aesculus hippocastanum, Causticum, Graphites, Hydrastis, Ignatia amara, Lachesis, Natrum muriaticum, Nitric acid, Paeonia officinalis, Ratanhia peruviana, Sepia, Sulphur, Silicia, Thuja, are helpful in this condition when selected on the basis of totality of symptoms. Surgery is required if the fissure does not heal with medication or it becomes the cause for secondary symptoms- the so-called complications.

Evaluation of Lord’s Anal Dilatation for Incontinence &amp; Recurrence in the Management of Anal Fissure

Background: Fissure-in-Ano is a commonly seen entity in surgical practice. Various approaches had been adapted since ages for its management including both conservative &amp; surgical. Amongst the surgical approaches Lord’s Anal Dilatation (LAD) is a modality long been practiced to manage patients not responding to conservative treatment &amp; those with chronic anal fissure. Recent trend is towards preferential practice of Lateral Internal Sphincterotomy (LIS) in the management of anal fissure. Pleaders of LIS are critical as well to the approach of LAD, although LAD in many clinical setups is still a widely practiced &amp; viable option, especially in third world countries. Objective of conducting this study is to evaluate the LAD in our hospital setup for its much debated complications of incontinence and recurrence. Methods: This descriptive study was designed &amp; carried out at the surgical units of Ayub Teaching Hospital Abbottabad from November 01, 2012 to May 31, 2017. A total of 129 patients with acute anal fissure (not responding to conservative measures, being in agony) &amp; chronic anal fissure (duration longer than 06 weeks) were included in study after taking informed consent. Patients were managed with LAD &amp; later followed for 01 year for the evidence of permanent flatus / faecal incontinence &amp; fissure recurrence. Results: Out of the 129 patients included in study we had successfully been able to follow 102 patients for one year, while 27 patients were lost at various stages of follow-up and thus dropped off the final stage of study (i.e. calculation of incontinence &amp; recurrence rate). Post-operative pain intensity &amp; early mobility factor was found much better in this study. 23 patients initially complaining of flatus incontinence for 02–09 days were settled with pelvic floor exercises while none was found with an early or late complication of faecal incontinence. Similarly follow-up for 01 year period revealed none with recurrence issue. Conclusion: LAD in our study proved a safe &amp; effective approach in the management of patients with anal fissure un-responsive to conservative measures, having no permanent incontinence or recurrence issues &amp; may therefore be safely practiced in our setup like LIS procedure. Keywords: Anal fissure, Lord’s anal dilatation, lateral internal sphincterotomy, incontinence, recurrence

Botox injection for anal fissure management: case report

Introduction: Anal fissure is shallow tear in the anoderm distal to dentate line which is considered most common proctologic condition. Anal fissure is generally located in the posterior midline. The symptoms include anal pain, spasm, and/or bleeding during defecation1. The pain can be so intense as to induce the patient to avoid defecation with consequent hardening of the feces and exacerbation of the problem2. Management of the anal fissure is improving diet and defecation habit, medical therapy and surgical therapy. The goal of medical treatment for chronic anal fissure is to temporarily reduce pressure of the anal canal to facilitate the healing of the fissure (“reversible sphincterotomy”), thereby reducing muscle tone. Intrasphincteric Botulinum Toxin A injection seems to be a reliable option.&#x0D; Case reports: two male patients were diagnosed with anal fissures, the patients complained of pain and spasm. They were treated with botulinum toxin type A (100 unit AllergenÒ), injected into three sites of the internal sphincter at 2, 5 and 8 o’clock. The symptoms relieved and the anal fissure healed within one month. There was no sign of relapse or incontinence during 12 months of follow-up.&#x0D; Conclusion: Botulinum toxin therapy can be considered as efficacious, effective and safe treatment for anal fissures.&#x0D; &#x0D; Keywords: anal fissure, botox, botulinum toxin, intrasphincteric

A comparative study of bilateral lsias verses conservative management in acute anal fissure

Background: Anal fissure is a tear in anal canal just below dentate line. It can be acute or chronic. In most patients, it is located in posterior midline. Its treatment is both conservative and surgical. In conservative management, there are no clear guidelines and its goal is to break the cycle of anal sphincter spasm allowing improved blood flow to fissured area for healing. Surgery is considered for patients not responding to conservative measures and its gold standard is lateral internal sphincterotomy.Methods: This prospective study was conducted among 60 patients with acute anal fissure. Patients were randomly divided into two study groups based on treatment protocols conservative management and Bilateral LSIAS. Prior informed written consent was obtained. Demographic profile, history, investigations, diagnosis, treatment and follow-up data was recorded and analyzed.Results: Patients with Bilateral LSIAS got pain relief immediately after surgery. 57% patients with conservative management reported head-ache and perianal itching. Over 86% of patients with Bilateral LSIAS got relief from pain and discomfort after treatment; around over 46% patients with conservative approach, had pain and discomfort after 6 weeks of treatment.Conclusions: Results show that Bilateral LSIAS surgery is a better approach than conservative management of anal fissure. Further, the Bilateral LSIAS surgery has maximum chances of early recovery and pain relief and reduced chances of progression to chronic anal fissure. Hence, we can conclude that for anal acute fissure, Bilateral LSIAS surgery procedure is the treatment of choice.

The effect of salty warm sitz bath on the conservative management of anal fissure

Background: The benefits of the sitz bath method in the management of anorectal diseases in general and anal fissure, in particular, are still not scientifically well-established. In our study, we aim to analyze the effectiveness of the sitz bath method as part of a conservative management protocol to treat anal fissure among Saudi Arabians who fear the surgical option for particularly religious reasons.Methods: The 539 Saudi Arabian patients with acute or chronic anal fissures between January 2004 and December 2013 were included. 386 were male and 153 were female with a mean age of 25.68±5.7 years. The conservative management protocol consisted of three times per day salty warm sitz bath, 2 grams glycerin suppositories per rectum 20 minutes before defecation as lubricant and laxative, Metamucil bulk-forming fiber (a mix of one dose-sachet-within 240 milliliters (8 oz) of cold liquid) once daily after breakfast for constipation.Results: The 379 (70.3%) patients had complete healing with a duration range from 3-7 weeks, while 160 (29.7%) patients did not heal and required surgical intervention. The recurrence rate was 0% in both groups after two years of follow-up.Conclusions: We conclude that sitz bath as part of a conservative management protocol to treat anal fissure showed promising results which were a significant benefit to patients who were reluctant to undergo lateral anal sphincterotomy and dilatation because of the fear to lose anal control. We recommend further specialized studies to investigate the role of sitz bath in the conservative management of anal fissure.