Anal Fissure (cont.)

• Anal fissures are cracks or tears in the anus and anal canal. They may be acute or chronic.
• Anal fissures are caused primarily by trauma, but several non-traumatic diseases are associated with anal fissures and should be suspected if fissures occur in unusual locations.
• The primary symptom of anal fissures is pain during and following bowel movements. Bleeding, itching, and a malodorous discharge also may occur.
• Anal fissures are diagnosed and evaluated by visual inspection of the anus and anal canal. Endoscopy and, less commonly, gastrointestinal X-rays may be necessary.
• Anal fissures are initially treated conservatively by adding bulk to the stool, softening the stool, consuming a high fiber diet, avoiding "sharp" or poorly digested foods, and utilizing sitz baths.
• Ointments containing anesthetics, steroids, nitroglycerin, and calcium channel blocking drugs are used for treating anal fissures that fail to heal with less conservative management.
• Injections of botulinum toxin may be effective when ointments are not effective. (The cost of treatment would be substantially reduced if the toxin were packaged in smaller doses.)
• Surgery by lateral sphincterotomy is the gold standard for curing anal fissures. Because of complications, however, it is reserved for patients who are intolerant of non-surgical treatments or in whom non-surgical treatments have proven to be ineffective.

REFERENCE: MedscapeReference. Anal Fissure.

Source: MedicineNet.com
http://www.medicinenet.com/anal_fissure/article.htm