Sacral Nerve Stimulation: A Novel Treatment of Chronic Anal Fissure

Abstract

Sacral nerve stimulation offers an effective alternative treatment option for chronic anal fissure in patients who chose not to pursue more invasive surgical interventions.

Randomized clinical trial of transcutaneous electrical posterior tibial nerve stimulation versus lateral internal sphincterotomy for treatment of chronic anal fissure

“…Sacral nerve stimulation (SNS) has been used since the 1980s as a treatment for dysfunction of pelvic and abdominal organs and pelvic pain. Sacral nerve stimulation has been recently shown to be an effective treatment modality for CAF as reported in a study which included five patients suffering CAF [10]. Complications related to SNS therapy include patients discomfort at the subcutaneous tunnel in which the electrodes run [19] and superficial wound infection which occurs in 3%e17% of patients [19,20].…”

“…Recurrence was observed in 11 (40.7%) of 27 patients who reported clinical improvement. Yakovlev et al [10] performed a pilot study on five patients with CAF who underwent SNS and reported that all study participants showed improvement with no recurrence of anal fissure 1 year after treatment. Altunrende et al [22], applied transcutaneous electrical posterior tibial nerve stimulation for ten patients with CAF and reported improvement of symptoms in all patients by the tenth session.…”

“…The diagnosis was based on the following clinical criteria [1]: evidence of posterior circumscribed ulcer with presence of indurated edges, visible internal sphincter fibers at the base of the fissure, a sentinel polyp at the distal end of the fissure or a fibroepitheliomatous polyp at the apex; and [2] symptoms (postdefecatory and/or nocturnal pain, bleeding) persistently present for over 2 months that had failed to resolve. Exclusion criteria included [1]: patients younger than 18 years [2]; patients with laterally located or painless fissures [3]; concurrent fistula or significant hemorrhoidal disease [4]; inflammatory bowel disease [5]; diabetes mellitus [6]; pregnancy [7]; neurological disease [8]; spinal cord lesions [9], use of cardiac pacemaker [10]; previous anal surgery or previous episiotomy. Males and females were considered for inclusion.…”

“…Pharmacological treatments have been investigated but the results are still inferior to those for lateral sphincterotomy [4]. Sacral nerve stimulation has been recently tried for management of CAF with promising results [10,11]. However, the technique described is invasive with the need for surgically implantable expensive stimulator electrodes.…”

Transcutaneous Electrical Posterior Tibial Nerve Stimulation for Chronic Anal Fissure: A Preliminary Study.

“…because the relief of the spasm has been associated with relief of pain and healing of the fissure [3].…”