Abstract:Chronic anal fissure (CAF) is a painful tear or crack which occurs in the anoderm. The optimal algorithm of therapy for CAF is still debated. Lateral internal sphincterotomy (LIS) is a surgical treatment, considered as the 'gold standard' therapy for CAF. It relieves CAF symptoms with a high rate of healing. Chemical sphincterotomy (CS) with nitrates, calcium blockers or botulinum toxin (BTX) is safe, with the rapid relief of pain, mild side-effects and no risk of surgery or anesthesia, but is a statistically … Show more
“…Previous studies have reported that anal resting pressure is a primary reason the AF does not self-heal because anal hypertonia results in low perfusion and ischemia of the overlying anoderm [13]. Figure 2 shows a relationship between anal pressure and anal blood flow.…”
Section: Discussionmentioning
confidence: 93%
“…Microtrauma of the anoderm and AF causes anal pain that aggravates IAS spasms causing high anal pressure which contributes to decreased anal perfusion. It is generally believed that decreased anal pressure is associated with an improvement in anodermal perfusion by the vascular endothelium after trauma, which leads to smooth muscle contraction [6,13]. Figure 2 shows a relationship between anal pressure and anal blood flow.…”
Section: Discussionmentioning
confidence: 96%
“…Furthermore, previous studies have shown that anal hypertonia is secondary to spasm created by defecation [13,17,18]. Microtrauma of the anoderm and AF causes anal pain that aggravates IAS spasms causing high anal pressure which contributes to decreased anal perfusion.…”
Section: Discussionmentioning
confidence: 97%
“…However, the role of impaired blood flow in the pathogenesis of AF is unclear. Although most reports exist in the literature the presence of an increased tone of the internal anal sphincter (IAS) represents the most reliable cause of fissuring and symptoms [1][2][3][4][5][6][7][8][9][12][13][14][15].…”
Diltiazem application is effective and safe for the treatment of AF in children, and has a low recurrence rate. The smooth dose-concentration curve causes minimal side effects.
“…Previous studies have reported that anal resting pressure is a primary reason the AF does not self-heal because anal hypertonia results in low perfusion and ischemia of the overlying anoderm [13]. Figure 2 shows a relationship between anal pressure and anal blood flow.…”
Section: Discussionmentioning
confidence: 93%
“…Microtrauma of the anoderm and AF causes anal pain that aggravates IAS spasms causing high anal pressure which contributes to decreased anal perfusion. It is generally believed that decreased anal pressure is associated with an improvement in anodermal perfusion by the vascular endothelium after trauma, which leads to smooth muscle contraction [6,13]. Figure 2 shows a relationship between anal pressure and anal blood flow.…”
Section: Discussionmentioning
confidence: 96%
“…Furthermore, previous studies have shown that anal hypertonia is secondary to spasm created by defecation [13,17,18]. Microtrauma of the anoderm and AF causes anal pain that aggravates IAS spasms causing high anal pressure which contributes to decreased anal perfusion.…”
Section: Discussionmentioning
confidence: 97%
“…However, the role of impaired blood flow in the pathogenesis of AF is unclear. Although most reports exist in the literature the presence of an increased tone of the internal anal sphincter (IAS) represents the most reliable cause of fissuring and symptoms [1][2][3][4][5][6][7][8][9][12][13][14][15].…”
Diltiazem application is effective and safe for the treatment of AF in children, and has a low recurrence rate. The smooth dose-concentration curve causes minimal side effects.
“…2,12 Headaches also occur in a similar proportion of patients using topical calcium channel blockers, however they occur less frequently so may be more tolerable. 3 Patients using topical glyceryl trinitrate should not take sildenafil, tadalafil or vardenafil due to the risk of hypotension. For patients with angina or heart failure taking nitrates, topical glyceryl trinitrate may cause nitrate tolerance if used during the nitratefree interval.…”
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