Anal fissure: the changing management of a surgical condition

Chronic anal fissure is a common benign disorder that causes severe, sharp anal pain during defaecation. Fissures are generally associated with raised resting anal pressures, and treatments are aimed at reduction of these pressures. Surgical sphincterotomy is very successful at healing fissures but is associated with significant morbidity. Much work has gone into the development of new pharmacological agents that can promote healing of chronic anal fissures by production of a reversible chemical sphincterotomy, with the aim of avoiding long-term problems of incontinence.

We review these recent innovations that have largely replaced surgery as first line treatment for chronic anal fissure.

Despite there being initial success with many of these pharmacological agents in the treatment of patients with chronic anal fissures, there are still some concerns about their use. In particular, the occurrence of side effects limits their use, and, unfortunately, they are not always effective at healing fissures. However, despite these drawbacks they remain excellent first-line options in the treatment of chronic anal fissures, and surgery should be offered only to patients who fail these therapies.