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Anal Fissure

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Coloproctology

Part of the book series: European Manual of Medicine ((EUROMANUAL))

Abstract

An anal fissure is a tear in the epithelial lining of the anal canal, distal to the dentate line. It is accompanied by a significant increase in the tone of the internal anal sphincter. Anal pain is usually intense, occurs during or minutes after a bowel movement, and can last from minutes to hours. It may be accompanied by minimal bleeding. A fissure is usually located in the posterior (in 90 % of cases) or anterior midline (in 10 % of women and 1–5 % of men with anal fissure). If there are multiple fissures or occur at a lateral position, other anal pathologies must be ruled out (e.g., tuberculosis, syphilis, HIV, Crohn’s disease). Treatment of anal fissure is based on general measures and pharmacological intervention. General measures consist of sitz baths, avoiding the presence of hard stools by using laxatives or significantly increasing fiber intake, and using analgesics. Pharmacological treatment is based on three groups: a nitric oxide donor (glyceryl trinitrate), calcium channel antagonists (diltiazem, nifedipine), and botulinum toxin. The results of these treatments are better than placebo but inferior to surgery. If these treatments fail, surgery is the best option. Sphincterotomy is an outpatient procedure with a success rate greater than 90 %, but it has a postoperative incontinence rate between 3 % and 15 %. A chance of postoperative incontinence is the main reason why drug treatment is now considered as the first therapeutic option, especially in patients with a high risk for incontinence.

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Abbreviations

BT:

Botulinum toxin

GTN:

Glyceryl trinitrate

IAS:

Internal anal sphincter

ISDN:

Isosorbide dinitrate

NO:

Nitric oxide

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Acknowledgements

The author thanks Dr. Isaac Felemovicious for reviewing the grammatical aspects of the chapter.

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Authors and Affiliations

  1. Hospital Valle de Hebron. Universitat Autonoma de Barcelona, Pg Valle de Hebron 119-129, 4 planta Hospital General, Barcelona, 08035, Spain

    Eloy Espin MD, PhD

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  1. Eloy Espin MD, PhD
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Correspondence to Eloy Espin MD, PhD .

Editor information

Editors and Affiliations

  1. End- und Dickdarm-Zentrum Mannheim, Mannheim, Germany

    Alexander Herold

  2. Clinique de chirurgie digestive et endocrinienne, Institut des maladies de l’appareil digestif, Hotel Dieu, Nantes, France

    Paul-Antoine Lehur

  3. Chirurgische Klinik mit Poliklinik, Universitaet Erlangen, Erlangen, Germany

    Klaus E. Matzel

  4. UCD School of Medicine, St Vincent’s University Hospital, Dublin, Ireland

    P. Ronan O'Connell

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Espin, E. (2017). Anal Fissure. In: Herold, A., Lehur, PA., Matzel, K., O'Connell, P. (eds) Coloproctology. European Manual of Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53210-2_5

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  • DOI: https://doi.org/10.1007/978-3-662-53210-2_5

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