Purpose of review Anal fissures
are very common. They are easy to diagnose and treat in the office setting. They may coexist with hemorrhoids. In fact 20% of patients with hemorrhoids have anal fissures
also. The purpose of this review is to highlight current diagnosis and treatment of anal fissures
using diet, ointments and botulinum toxin
to enable healing. Medical treatment relies on reducing anal sphincter spasm
to allow improved blood flow and healing.
Many anorectal disorders can be managed in the office. Most anal fissures
can be managed without the need for surgery. The need for anorectal examination, including use of anoscopy is stressed in the current literature. The use of calcium channel blockers
in preference to nitroglycerin is highlighted as well as the use of botulinum toxin
when ointments don’t work.
Anal fissure can be managed nonsurgically most of the time and gastroenterologists should be able to manage them. This article should help in preventing unnecessary surgery and its complications, mainly incontinence in a small but significant number. The search for more effective drugs and options for managing this disorder continues.