Anal Fissure – an extensive update

Abstract

Anal fissure is one of the most common anorectal diseases resulting from a longitudinal tear in anoderm under the dentate line. It causes painful defecation and bleeding per anum. Most of the fissures heal by conservative means but a significant proportion turns chronic leading to a negative impact upon the overall quality of life of a patient. The treatment options for chronic fissures are generally based on reducing the anal pressures and include non-surgical and surgical options. Lateral internal sphincterotomy still remains the gold standard for definitive management of anal fissure though anal incontinence is a serious complication of the procedure. In recent years, various modifications have evolved to minimize changes of incontinence besides the evolution of wide range of non-surgical options of management. This review outlines the key points in the clinical presentation, etio-pathogenesis, impact on quality of life and management of anal fissure in the light of the recent updates in literature.