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Related Experiment Videos

Chronic Anal Fissure.

Miguel Minguez1, Belen Herreros, Adolfo Benages

  • 1Gastroenterology Service, University Clinical Hospital of Valencia, 46010 Blasco Ibanez Avenue, Valencia, Spain. mminguezp@meditex.es

Current Treatment Options in Gastroenterology
|May 15, 2003
PubMed
Summary

Chronic anal fissures, often linked to anal sphincter issues, can be treated with surgery or medical options. Botulinum toxin injections offer an effective alternative to surgery with fewer side effects, especially for patients at risk of incontinence.

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Area of Science:

  • Gastroenterology and Colorectal Surgery
  • Anal Fissure Pathophysiology and Treatment

Background:

  • Chronic anal fissures are common, with etiology often linked to anal sphincteric hypertonia and ischemia.
  • High recurrence rates suggest chronic disease evolution influenced by sphincter characteristics.
  • Conservative measures like increased fiber intake aid symptom management and healing.

Purpose of the Study:

  • To review current understanding of chronic anal fissure etiology and pathogenesis.
  • To compare the effectiveness and side effect profiles of various treatment modalities.
  • To provide guidance on individualized treatment selection for chronic anal fissure.

Main Methods:

  • Review of existing literature on chronic anal fissure diagnosis, etiology, and treatment.

Related Experiment Videos

  • Comparison of surgical (lateral internal sphincterotomy) and medical treatments (botulinum toxin, topical nitroglycerin, others).
  • Analysis of efficacy, recurrence rates, and adverse effects, including fecal incontinence.

    • Main Results:

    • Lateral internal sphincterotomy is highly effective (>95%) with low recurrence (1-3%) but carries risks of permanent incontinence.
    • Botulinum toxin injections demonstrate comparable effectiveness to surgery with minimal adverse effects (transient mild incontinence).
    • Topical nitroglycerin has lower efficacy (60-70%) and more side effects (headache); other topical agents show promise but lack extensive data.

    Conclusions:

    • Treatment for chronic anal fissure should be individualized based on patient clinical profiles.
    • Botulinum toxin injection is a recommended medical option, particularly for patients at risk of incontinence.
    • Further research is needed for other topical treatments, but botulinum toxin offers a viable alternative to surgery.