Anal fissure management by the gastroenterologist

Mathur, Neha; Qureshi, Waqar

doi:10.1097/mog.0000000000000599

Cited by 11 publications

(16 citation statements)

References 27 publications

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“…[ 32 , 33 ] Furthermore, the toxin was shown to be superior to nitro derivatives in inducing healing of chronic AF. [ 34 , 35 ] Considering it as a mechanism, in our study, similarly, we temporarily reduced muscle tone and resolved muscle spasm without permanent damage to the anal sphincter, thereby accelerating blood circulation in the anal region and providing wound healing in patients with incontinence risk.…”

Section: Discussionmentioning

confidence: 57%

The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure

Gökçek,

Gökçe,

Kaçar

2023

Medicine

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Background: Chronic anal fissure is called the reaching the muscle layer under the skin by deepening of the fissure in the breech skin. Our purpose is to enable the tissue to heal by relaxing the anal sphincter with caudal epidural injection. Methods: One hundred twenty cases were included in this randomized, controlled study. The cases were categorized into 2 groups; Under ultrasound guidance, the first group, caudal epidural injection group (Group CE, n = 60) was treated with 5 cc bupivakain + 5 cc isotonic from a caudal epidural for a total of 3 sessions at the beginning, 1 week and 2 weeks later; the second group, control group (Group C, n = 60) were provided medical treatment (cream, pill etc.) every day for 2 weeks. Wexner’s constipation score was used to assess constipation severity and visual analog scale was used to assess pain severity. Short Form-36 was used to determine the patient’s quality of life. Results: This study was conducted with 2 groups of 60 people and a total of 120 patients. There was no statistically significant difference between the groups in terms of demographic characteristics (age, body mass index, gender, American Society of Anesthesiologist, mean blood pressure, heart rate) (P > .05). Out of the detected fissures, 32 (26.7%) were located anteriorly and 88 (73.3%) were located posteriorly. The groups were statistically same in terms of fissure location (P = .423). When groups were compared with pain, Wexner constipation and visual analog scale scores decreased significantly in Group CE compared to Group C after 2.and 3.sessions (P = .001 and P = .002, respectively). In Group CE, the Short Form-36 subscales increased significantly (P = .003). Conclusion: Caudal epidural injection has a potential to be an alternative treatment option for chronic anal fissure.

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Section: Discussionmentioning

confidence: 57%

The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure

Gökçek,

Gökçe,

Kaçar

2023

Medicine

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“…The toxin induces a significant reduction in the resting anal tone [26,32]. Furthermore, the toxin was shown to be superior to nitro derivatives in inducing healing of chronic AF [26,27,33,34].…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin injection for the treatment of chronic anal fissure: uni- and multivariate analysis of the factors that promote healing

Brisinda

Chiarello

Crocco

et al. 2022

Int J Colorectal Dis

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Purpose Anal fissure is caused by a pathological contraction of the internal anal sphincter. Lateral internal sphincterotomy remains the gold standard for the treatment of fissure. Botulinum toxin injections have been proposed to treat this condition without any risk of permanent injury of the internal sphincter. We investigate clinical and pathological variables and the effects of different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure. Methods This is a retrospective study at a single center. The patients underwent a pre-treatment evaluation that included clinical inspection of the fissure and anorectal manometry. We collected and analyzed demographic data, pathological variables, associated pathological conditions, and treatment variables. Success was defined as healing of the fissure, and improvement of symptoms was defined as asymptomatic persistent fissure. Results The findings of 1003 patients treated with botulinum toxin injections were reported. At 2 months evaluation, complete healing was evident in 780 patients (77.7%). Resting anal tone (77.1 ± 18.9 mmHg) was significantly lower from baseline (P < 0.0001) and from 1-month value (P = 0.0008). Thirty-nine not healed patients underwent lateral internal sphincterotomy, and 184 were re-treated with 50 UI of botulinum toxin. In these patients, the healing rate was 93.9% (171 patients). Dose and injection site of toxin correlates with healing rate. There were no relapses during an average of about 71 months. Conclusion Our data show that injection of botulinum toxin into the internal anal sphincter is a safe and effective alternative to surgery in patients with chronic anal fissure.

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“…Primary fissures are classified as acute (< 6 weeks) or chronic (> 6 weeks and/or clinical characteristics of chronicity/fibrosis). They are typically located on the posterior (and less often anterior) midline and associated with hypertonia of the internal anal sphincter (1,2). About 1% of anal fissures are atypical.…”

Section: Introductionmentioning

confidence: 99%

“…Atypical fissures are generally secondary in nature and therefore these atypical features require further exploration for underlying conditions, such as granulomatous diseases including Crohn's disease and tuberculosis, malignancy, chemotherapy, traumatic or iatrogenic causes, human immunodeficiency virus (HIV) and other venereal infections. Treatment is focused on the underlying condition (1,2).…”

Section: Introductionmentioning

confidence: 99%

Secondary anal fissures: a pain in the a**

Ruymbeke¹,

Geldof²,

Looze³

et al. 2023

AGEB

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An anal fissure is a painful tear of the sensitive anoderm, distally from the dentate line. It is a prevalent disorder and impairs quality of life dramatically. Typical or primary fissures are associated with constipation and mostly located at the posterior midline. About 1% of fissures are atypical in appearance and are generally secondary in nature. These secondary fissures should arouse attention and require further exploration for underlying conditions, such as Crohn’s disease, malignancy, trauma or venereal infections. The aim of this manuscript is to provide a comprehensive review on the clinical aspects, evaluation and treatment of secondary anal fissures.

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Anal fissure management by the gastroenterologist

Cited by 11 publications

References 27 publications

The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure

The effect of Caudal Epidural Injection on healing in the treatment of chronic anal fissure

Botulinum toxin injection for the treatment of chronic anal fissure: uni- and multivariate analysis of the factors that promote healing

Secondary anal fissures: a pain in the a**

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