Anal fissures originally are a superficial tear in the tissue which lines the anal canal. This superficial tear may deepen and eventually reach the underlying tissues. These tissues are the internal sphincter. With exposure to chronic irritation, the internal sphincter's function may become compromised,
Subsequently, sentinel tags, hypertrophied anal papilla and anal stenosis may occur.
Most patients with anal fissures relate pain with evacuation, rectal bleeding, itching, swelling and anal discharge. History is usually sufficient for the initial diagnosis. Eventually, further evaluation with palpation (rectal exam) and an endoscopic evaluation are useful.
The etiology of an anal fissure may be associated with constipation, diarrhea, rubber band ligation for hemorrhoids or injection of the anal area. Other diseases such as chlamydia, gonorrhea, herpes, syphilis, AIDS, neoplasms, tuberculosis, and Crohn's disease may also present as anal fissures. A gastrointestinal work-up for these diseases is based upon the patient's presentation and clinical history.
Treatment of anal fissures is divided into medical and surgical groups. Medical treatment of acute fissures is based upon topical creams, sitz baths, perirectal hygiene and dietary changes consisting of increasing fiber content.
When patients continue to experience symptoms for longer periods of times, surgical intervention is considered. Surgical intervention is best directed at chronic fissures. A lateral internal sphincterotomy is usually utilized. However, the surgeon may wish to proceed with an internal sphincterotomy or manual dilation depending upon the clinical situation.
Recurrent fissures, i.e. those fissures which fail to heal postoperatively, should undergo a complete gastrointestinal evaluation and be treated with medical therapy.
 |
 |
 |
|
|||