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Anal fissures
1Anorectal Physiology Unit, St George Hospital, Sydney, New South Wales.
Background:
Anal fissures are common conditions, presenting with bleeding, itching, and pain of varying severity. Pain and bleeding is frequently attributed to haemorrhoids, which may delay commencement of appropriate therapy. Other causes for bleeding must also be excluded, with investigations taking into account the clinical findings and the age of the patient.
Objective:
To discuss the pathogenesis and management of anal fissures.
Discussion:
Recent studies have changed our understanding of the pathophysiology of anal fissures. It is now known that the majority of fissures are caused by internal sphincter spasm and resulting in ischaemia of the anal mucosa. Pharmacological agents that relax the sphincter have provided a novel approach to treatment, allowing surgery to be avoided in some patients.