Abstract
Physiologically, it is the resting tone of the internal anal sphincter that chiefly interferes with the healing of the fissure. An anal fissure which does not heal with sitz baths and laxatives is a chronic anal fissure. Till now, the treatment for chronic anal fissures has been surgery in the form of anal dilatation or lateral sphincterotomy. Fissures heal in most patients, but a few develop transient or even permanent incontinence. There are exciting new advances in the form of chemical sphincterotomy, by the application of drugs that relax the sphincter. Glyceryl trinitrate and isosorbide dinitrate relax smooth muscle. They promote healing in about half of patients, but often cause headaches. Consequently compliance is a problem. The calcium antagonists, nifedipine and diltiazem, also reduce anal pressure by 28 %, but healing rates are low. Botulinum toxin is the most promising of the agents used for chemical sphincterotomy. This toxin can be used to weaken smooth muscle in the gastrointestinal tract, for example in achalasia and infantile hypertrophic pyloric stenosis. Botulinum toxin injection near the fissure reduces anal pressure lasts for about 3 months. This allows the fissure to heal, thus eliminating the need for surgery. After injection of botulinum toxin, there is a decrease in resting anal pressure by 18–30 %. The injection relieves the pain almost immediately. Cure rates are over 60 %, and the procedure can be repeated. Botulinum toxin is a reasonable first-line alternative to surgery in the management of chronic anal fissure.
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Jawad, K., Al-Kubaisy, W., Al Shaham, A., Sood, S., Mohammed Arpuin, Y. (2016). Pharmaceutical Manipulation of Chronic Anal Fissure. In: Yacob, N., Mohamed, M., Megat Hanafiah, M. (eds) Regional Conference on Science, Technology and Social Sciences (RCSTSS 2014). Springer, Singapore. https://doi.org/10.1007/978-981-10-0534-3_53
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DOI: https://doi.org/10.1007/978-981-10-0534-3_53
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