Diagnosis and treatment of anal fissure - Clinical Briefs - Brief Article

Author: Carrie Morantz, Brian Torrey
Date: March 1, 2004

The American Gastroenterological Association (AGA) has released a technical review on diagnosis and care of patients with anal fissure. "AGA Technical Review on the Diagnosis and Care of Patients with Anal Fissure" appears in the January 2003 issue of Gastroenterology and is available online at http://www.gastro. org.

Anal fissure is a common disorder but often is misdiagnosed as hemorrhoids. Its exact incidence and cause are unknown. Standard treatment traditionally has included fiber supplementation, sitz baths, and topical analgesics. However, this approach recently has been modified to include new treatment options.

Young adults are most frequently affected. The majority of fissures occur in the posterior midline, although anterior midline fissures occur in 25 percent of affected women and 8 percent of affected men. Physical examination confirms the diagnosis. Most fissures are best seen by separating the buttocks with opposing traction. A sentinel skin tag should alert the examiner to the likely presence of a fissure. Digital and endoscopic examinations are not appropriate in patients with marked tenderness, because these methods are traumatic to the patient and rarely yield diagnostic information. When significant anal pain cannot be diagnosed comfortably, examination under anesthesia is warranted.

Anal fissure is associated with elevated resting anal pressure, and therapy is directed at reducing anal tone. About one half of patients who receive standard conservative care will be healed. Preliminary reports of new treatments such as topical sphincter relaxants and locally injected botulinum toxin are promising, although some topical agents are not yet available commercially in the United States. Surgery is a highly successful treatment option; virtually all U.S. experts advocate lateral internal sphincterotomy (LIS) for patients with anal fissure. However, LIS has been associated with minor incontinence in some patients.

COPYRIGHT 2004 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

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