Management of Anal Fissures

- Introduction

The term anal fissure most commonly refers to a longitudinal tear within the anal canal, one that typically extends from the dentate line toward the anal verge. This benign anorectal ailment is quite common, although there have been virtually no published population-level data describing its incidence, ⁽¹⁾. Constipation and diarrhea are frequent antecedent historical features. The primary symptom associated is anal pain, which is often provoked by defecation and may last for several hours following defecation. Anorectal bleeding may also be associated with fissures, and, when this symptom is present, it can contribute to a misdiagnosis of symptomatic hemorrhoids. ⁽²⁾

Anal fissure may be treated medically or surgically. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient, ^{(3 & 4)}.

Up to 90% of cases, the anal fissure is located within the posterior midline of the anal canal. Fissures are located in the anterior midline in as many as 25% of female patients and in as many as 8% of male subjects. In3% of patients, fissures can be located at posterior and anterior positions simultaneously.

Fissures located at lateral locations within the anal canal, and multiple fissures, are considered to be atypical and require careful evaluation because of their association with such diseases as HIV infection, Crohn’s disease, syphilis, tuberculosis, and hematologic malignancies ⁽⁵⁾.