Perspective Chapter: The Management of Chronic Anal Fissures

Abstract

Chronic anal fissure is a common complaint that is associated with excruciating anal pain and bright red bleeding associated to bowel movements. The classic findings during the physical examination are helpful in differentiating the different types of fissures (acute versus chronic and typical versus atypical). Most cases of chronic anal fissures are successfully treated with conservative measures such as dietary and lifestyle modifications, adequate bowel regimen, and topical muscle relaxants such as nifedipine, diltiazem, or nitroglycerine. Refractory cases are usually managed with botulinum toxins injections or more invasive approaches such as internal lateral sphincterotomy with excellent healing rates at the expense of risk of fecal incontinence. In patients without hypertonicity of the anal sphincter, cutaneous flaps can be used with remarkable results.