Advertisement

International Journal of Colorectal Disease

, Volume 21, Issue 7, pp 673–675 | Cite as

Nitric oxide deficiency in the internal anal sphincter of patients with chronic anal fissure

  • Jonathan N. Lund
Original Article

Abstract

Anal fissure is a common condition affecting young to middle-aged adults. It causes severe pain on defecation and rectal bleeding. The aetiology remains uncertain. Spasm of the internal anal sphincter is a constant feature. Nitric oxide (NO) is the major inhibitory neurotransmitter of the internal anal sphincter (IAS). In other spasmodic conditions of the GI tract a lack of normal nitric oxide synthase (NOS) activity has been reported. The aim of this preliminary study was to compare the presence of NOS in the internal sphincters of patients with and without chronic anal fissure. Internal anal sphincter biopsies were taken under general anaesthesia from patients having lateral internal sphincterotomy for chronic anal fissure and from sphincter of patients having abdominoperineal resections as controls. Sections of IAS were stained to show the presence of NADPH diaphorase (and hence presence of NOS). Internal anal sphincter was taken from 6 patients with chronic anal fissure and 6 controls. IAS taken from patients with chronic anal fissure showed little NOS presence compared with controls. It may be that there is an abnormal failure of relaxation of internal sphincter in those patients who develop chronic anal fissure caused by an intrinsic lack of neural NOS in the internal anal sphincter.

Keywords

Anal fissure Nitric oxide Aetiology 

Notes

Acknowledgements

The author wishes to thank Dr. Keith Robson and Ms. Janet Palmer of the Department of Neuropathology, Queens Medical Centre, Nottingham, for their help in preparing this manuscript.

References

  1. 1.
    Lund JN, Scholefield JH (1996) The aetiology and treatment of anal fissure. Br J Surg 83:1335–1344PubMedCrossRefGoogle Scholar
  2. 2.
    Lindsey I, Jones OM, Cunningham C, Mortensen NJ (2004) Chronic anal fissure. Br J Surg 91:270–279CrossRefPubMedGoogle Scholar
  3. 3.
    Lund JN, Scholefield JH (1997) Internal sphincter spasm in anal fissure. Br J Surg 84:1723–1724CrossRefPubMedGoogle Scholar
  4. 4.
    O’Kelly T (1996) Nerves that say NO: a new perspective on the human rectoanal inhibitory reflex. Ann R Coll Surg Engl 78:31–38PubMedGoogle Scholar
  5. 5.
    Vanderwinden J-M, Mailleux P, Schiffmann SN, Vanderhaeghen JJ, De Laet MH (1992) Nitric oxide synthase activity in infantile hypertrophic pyloric stenosis. N Engl J Med 327:511–515PubMedCrossRefGoogle Scholar
  6. 6.
    Mearin F et al (1993) Absence of nitric oxide synthase in the gastroesophageal junction of patients with achalasia. Gastroenterology 104:550Google Scholar
  7. 7.
    Dawson TM, Bredt DS, Fotuhi M, Hwang PM, Snyder SH (1991) Nitric oxide synthase and neuronal NADPH diaphorase are identical in brain and peripheral tissues. Proc Natl Acad Sci USA 88:7797–7801PubMedCrossRefGoogle Scholar
  8. 8.
    Lund JN, Scholefield JH (1997) A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in the treatment of anal fissure. Lancet 349:11–14CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Wolfson Digestive Diseases Institute, School of Medical and Surgical SciencesUniversity of NottinghamNottinghamUK
  2. 2.Clinical Sciences Wing, The Medical SchoolDerby City HospitalDerbyUK

Personalised recommendations