An anal fissure is a painful condition associated with a linear tear at the anus secondary to defecation of hard stool or mucosal ischemia.
Clinical features of anal fissure:
(1) linear tear of skin and mucosa crossing the anus
(2) anal pain, especially on defecation
(3) anal sphincter spasm or hypertonia
(4) anal bleeding
(5) complications may include a sentinel skin tag, hypertrophied anal papillae and fibrosis
An acute anal fissure may heal spontaneously. A chronic fissure (one lasting >= 12 weeks according to Scholefield et al, others use > 6 weeks) usually requires some form of treatment before it resolves.
Management of Chronic Anal Fissue
Complications
surgical lateral sphincterotomy
fecal incontinence
nitroglycerin ointment (glyceryl trinitrate), 0.1 to 0.4%
headache
diltiazem hydrochloride (Cardiazem) ointment
botulinum toxin injection
where:
• The use of nitroglycerin may be referred to as a “chemical sphincterotomy”.
• Nitroglycerin results in release of nitrous oxide (NO) which relaxes smooth muscle.
• Diltiazem is a calcium channel blocker.
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