Anal fissure – new concepts and controversies in the diagnosis and treatment

Anal fissure is one of the most common as well as widespread benign diseases of the anus. Fissure development is initiated by a mechanical injury that is induced by hard faecal mass and remains unhealed if the blood flow in the tissue surrounding the fissure is reduced and the relaxation of the internal anal sphincter is impaired. Conservative treatment is administered as the initial treatment for anal fissures. In recent years, apart form the traditional treatment options, such as warm-water bath, ointments with nitro-glycerine or calcium-channel blockers, there have been reports of using new drugs for pharmacological sphincterotomy. They include bethanechol, which is a muscarinic receptor agonist, as well as sildenafil – a phosphodiesterase type 5 inhibitor which is a mild dilator of blood vessel smooth muscles. The authors describe a good therapeutic effect achieved with topical treatment with 7% sucralfate (sucrose sulphate-aluminium complex) ointment that is used for the treatment of peptic ulcers. Qualifications for the surgical treatment of anal fissure have been made significantly more stringent. Lateral sphincterotomy is the gold standard. The article presents a review of literature on various modifications of lateral sphincterotomy (among other things, segmental internal lateral sphincterotomy was presented). The authors believe that the new operative techniques require due caution and their actual efficacy and possible functional complications such as impaired continence, may be assessed only after a few years of follow-up.