Skip to main content


Log in

Ano-coccygeal support in the treatment of idiopathic chronic posterior anal fissure: a prospective non-randomised controlled pilot trial

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript



Idiopathic chronic anal fissure is believed to be a consequence of a traumatic acute anodermal tear followed by recurrent inflammation and poor healing due to relative tissue ischaemia secondary to internal sphincter spasm. This pilot trial compared the efficacy of a novel manufactured ano-coccygeal support attached to a standard toilet seat (Colorec) to the standard procedure of lateral internal sphincterotomy (LIS) for chronic anal fissure.


Fifty-three patients with confirmed chronic anal fissures were enrolled and assigned, based on their preference, to the test group and the control group. Each patient was reviewed after therapy, and follow-up was scheduled at 4, 6 and 8 weeks and at 6 months.


The fissure healing rate was 100 % in both groups. There were no statistically significant differences between the test group (n = 30, median age 42 years; range 20–71 years) and the control group (n = 22, median age 38 years; range 23–60 years) with regards to resolution of rectal bleeding at defaecation after 4 weeks (86.6 vs 72.7 %, p = 0.698), and by week 6, bleeding had resolved in 100 % of patients in both groups. There was no statistically significant difference between the test group and the control group with regards to pain scores at 4, 6 and 8 weeks (4.30 ± 0.79, 2.03 ± 0.80, 0.43 ± 0.50 vs 3.50 ± 0.74, 1.68 ± 0.56, 0.50 ± 0.51, p = 0.054) and to time until complete healing of fissures (5.60 ± 1.52 weeks vs 5.91 ± 1.57 weeks, p = 0.479). After continuous use of the ano-coccygeal support over 6 months, no patients in the test group had recurrent fissures. No complications were observed during the trial.


Results of both methods were comparable and demonstrated that the ano-coccygeal support is at least as effective as LIS, without any short-term complications. Larger and randomised trials on the use of ano-coccygeal support for chronic anal fissures are awaited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Lund JN, Scholefield JH (1996) Aetiology and treatment of anal fissure. Br J Surg 83:1335–1344

    Article  PubMed  CAS  Google Scholar 

  2. Collinson RJ, Mortensen NJMcC (2007) Is botulinum toxin injection a better treatment than nitroglycerin ointment for patients with chronic anal fissure? Nat Clin Pract Gastroenterol Hepatol 4:598–599

    Article  PubMed  Google Scholar 

  3. Farouk R, Duthie GS, MacGregor AB, Bartolo DC (1994) Sustained internal sphincter hypertonia in patients with chronic anal fissure. Dis Colon Rectum 37:424–429

    Article  PubMed  CAS  Google Scholar 

  4. Schouten WR, Briel JW, Auwerda JJ, De Graaf EJ (1996) Ischaemic nature of anal fissure. Br J Surg 83:63–65

    Article  PubMed  CAS  Google Scholar 

  5. Orsay C, Rakinic J, Perry WB et al (2004) Standards practice task force; American society of colon and rectal surgeons. Practice parameters for the management of anal fissures (revised). Dis Colon Rectum 47:2003–2007

    Article  PubMed  Google Scholar 

  6. Carapeti EA, Kamm MA, McDonald PJ, Chadwick SJ, Melville D, Phillips RK (1999) Randomised controlled trial shows that glyceryl trinitrate heals anal fissures, higher doses are not more effective, and there is a high recurrence rate. Gut 44:727–730

    Article  PubMed  CAS  Google Scholar 

  7. Nelson RL (2003) Treatment of anal fissure. BMJ 327:354–355

    Article  PubMed  Google Scholar 

  8. Jones OM, Ramalingam T, Merrie A et al (2006) Randomized clinical trial of botulinum toxin plus glyceryl trinitrate versus botulinum toxin alone for medically resistant chronic anal fissure: overall poor healing rates. Dis Colon Rectum 49:1574–1580

    Article  PubMed  CAS  Google Scholar 

  9. Casillas S, Hull TL, Zutshi M, Trzcinski R, Bast JF, Xu M (2005) Incontinence after a lateral internal sphincterotomy: are we underestimating it? Dis Colon Rectum 48:1193–1199

    Article  PubMed  Google Scholar 

  10. Levin A, Cohen MJ, Mindrul V, Lysy J (2011) Delayed fecal incontinence following surgery for anal fissure. Int J Colorectal Dis 26(12):1595–1599

    Google Scholar 

  11. Baraza W, Boereboom C, Shorthouse A, Brown S (2008) The long-term efficacy of fissurectomy and botulinum toxin injection for chronic anal fissure in females. Dis Colon Rectum 51:239–243

    Article  PubMed  Google Scholar 

  12. Poh A, Tan KY, Seow-Choen F (2009) Innovations in chronic anal fissure treatment: a systemic review. World J Gastrointest Surg 2:231–241

    Article  Google Scholar 

  13. Chen CM, Seow-Choen F (2010) Randomised clinical trial comparing topical nitroglycerin and posterior perineal support with topical nitroglycerin only for chronic anal fissure. World J Colorec Surg 2:1–13

    Google Scholar 

  14. Tan KY, Seow-Choen F, Hai CH, Thye GK (2009) Posterior perineal support as treatment of anal fissures: preliminary results with a new toilet seat device. Tech Coloproctol 13:11–15

    Article  PubMed  Google Scholar 

  15. Beco J (2010) Posterior perineal support during defecation, descending perineum syndrome, pudendal neuropathy and anal fissures. Tech Coloproctol 14:193–194

    Article  PubMed  CAS  Google Scholar 

Download references


The authors would like to thank Mohd Faizal Ramli of the Clinical Research Department, Institut Jantung Negara, Kuala Lumpur for his contribution to the statistical methods and analysis. This study was funded by University Putra Malaysia Research Grant and Science Fund.

Conflict of interest

The authors declare that no conflict of interest exists.

Author information

Authors and Affiliations


Corresponding author

Correspondence to T. Gee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gee, T., Hisham, R.B., Jabar, M.F. et al. Ano-coccygeal support in the treatment of idiopathic chronic posterior anal fissure: a prospective non-randomised controlled pilot trial. Tech Coloproctol 17, 181–186 (2013).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: