Conservative Management of Anal Fissures

Clinical Practice Guideline for the Management of Anal Fissures.

Anal fissures; first do no harm.

emergency centre staffed with GPs, nurse practitioners, and emergency medicine doctors. Handover between OOH and in-hours GPs has been defined as ‘one of the most perilous procedures in medicine, and when carried out improperly can be a major contributory factor to subsequent error and harm to patients’.1 In-hours care accounts for 50 hours/week while OOH care accounts for 118 hours/week. Hando...

Neuromyogenic Properties of the Internal Anal Sphincter: Applications for the Treatment of Anal Fissures

Pharmacological therapy of anal fissures reduces maximum resting pressure (MRP), allowing healing by promoting anodermal vascular perfusion. In this thesis the clinical and manometric responses to diltiazem and botulinum toxin and the therapeutic potential of indoramin and salbutamol were investigated. A porcine internal anal sphincter model was developed to validate the responses to pharmacolo...

Conservative treatment for anal incontinence

Anal incontinence (AI) in adults is a troublesome condition that negatively impacts upon quality of life and results in significant embarrassment and social isolation. The conservative management of AI is the first step and targets symptomatic relief. The reported significant improvement with conservative treatments for AI is close to 25% and involves prescribed changes in lifestyle habits, a r...

Neuromyogenic properties of the internal anal sphincter: therapeutic rationale for anal fissures.

Lateral sphincterotomy diminishes internal anal sphincter hypertonia and thereby reduces anal canal pressure. This improves anal mucosal blood flow and promotes the healing of anal fissures. However, sphincterotomy can be associated with long term disturbances of sphincter function. The optimal treatment for an anal fissure is to induce a temporary reduction of anal canal resting pressure to al...