Articles on Anal Fissures

Botulinum toxin for the treatment of secondary chronic anal fissure.

Madalinski MH.

Second Department of Internal Medicine, St. Wojciech-Adalbertus Hospital, Gdansk, Poland. m.h.madalinski@pro.onet.pl

Tech Coloproctol. 2003 Jul; 7(2): 85-8; comment 88.

BACKGROUND: Botulinum toxin A (BT-A) injection into internal or external anal sphincter causes relaxation of the anal sphincters, enhancing microcirculation at the fissure site and promoting fissure healing. There are no such observations in patients with secondary anal fissure. METHODS: Six patients with fissures after surgical or nonsurgical treatment of hemorrhoids and four patients with ulcerative colitis received injections of BT-A on both edges of the fissure (total dose, 25 U Botox). RESULTS: In the week following BTA injection, patients with fissure after hemorrhoids treatment had relief of fissure symptoms, but one month later the fissures still existed. They then received an additional 25 U Botox. One month after the second BT-A injection, all fissures were healed. The patients with ulcerative colitis had only symptomatic improvement after BT-A injection. CONCLUSION: BT-A therapy seems effective for the treatment of chronic anal fissure after surgical or nonsurgical treatment of hemorrhoids.

Lateral internal anal sphincterotomy for anal fissure: with or without associated anorectal procedures.

Syed SA, Waris S, Ahmed E, Saeed N, Ali B.

Department of General Surgery/Medicare Hospital and Fatima Medical Centre, Multan/ Nishtar Medical College and Hospital, Multan. shahabahmedsyed@hotmail.com

J Coll Physicians Surg Pak. 2003 Aug; 13(8): 436-9.

OBJECTIVE: To confirm or refute the validity of the fear associated with anal sphincterotomy for anal fissure, particularly when performed with other anorectal procedures. DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Surgical Wings - Medicare Hospital and Fatima Medical Center, Multan, over a period of 8 years from January 1994 to December 2001. SUBJECTS AND METHODS: Records of 112 anal fissure patients, 46 (41.0%) males and 66 (58.9%) females, ranging in age from 12-95 years (mean 39) were studied. All patients with acute or chronic anal fissures with or without other anorectal pathologies were included. Seventeen patients who had anal dilatation and 2 recurrent fissures were excluded. Open technique of anal sphincterotomy was employed in all cases. Results were recorded and analyzed. RESULTS: Fissures were acute in 16 (14.2 %) and chronic in 96 (85.7 %) patients. Anterior fissure was present in 20 (17.8%), posterior in 80 (71.4%), both in 9 (8.0%) and lateral or multiple fissures in 3 (2.6%) cases. Commonest associated pathology was haemorrhoids; encountered in 64 (57.1%) patients. Minor complications, taken together, occurred in 20 (17.8%) patients. Urinary retention was seen in 3 (2.6%) with lateral internal anal sphincterotomy (LIAS), and in 6 (5.3%) where haemorrhoidectomy was added. Haemorrhage in 2 (1.7%), temporary loss of flatus control in 3(2.6%) and soiling of clothes in 2 (1.7%) patients was encountered. No permanent loss of flatus or faecal control and recurrence has been reported to-date. CONCLUSION: Anal sphincterotomy with or without other anorectal procedures can be safely practiced in properly selected patients. Postoperatively, ablution with mild antiseptic added to plain water is adequate in maintaining hygiene to promote healing.

[Epidemiology of anal lesions (fissure and thrombosed external hemorroid) during pregnancy and post-partum]

Abramowitz L, Batallan A.

Service de gastro-enterologie et Famya de coloproctologie, hopital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France. laurent.abramowitz@bch.ap-hop-paris.fr

Gynecol Obstet Fertil. 2003 Jun; 31(6): 546-9. [Article in French]

Thrombosed external hemorrhoids (TEH) and anal fissure (AF) are 2 frequent sources of anal pains during childbirth. We are going to define their incidences as available in publications and in our experience in Bichat hospital. Then we will define their risk factors. According to Martin's and Corby's studies, AF was observed in 10% of the delivered women. In Bichat hospital we performed a proctological assessment to 165 pregnant women during the last third of pregnancy and within the 2 months following delivery. We observed 2 AF (1,2%) during the first period and 25 (15,2%) during the second. Rouillon et al. reported an incidence of TEH in 12,2% (20/164), while Pradel and al. reported 34% (18/52) of it. In Bichat hospital, 13 women (7,9%) were presenting with TEH during the last third of pregnancy and 33 (20%) in post-partum period. Two studies looked for a statistical correlation between AF and obstetrical, foetal or maternal factors. Corby et al. only pointed the role of constipation. In our study, terminal constipation was the most important risk factor for AF with 5.7 (2.7-12), odds ratio (95% confidence intervals). Rouillon et al. observed more TEH among women with a prolonged first stage labor and a big baby. In our study, a big baby and mother little lips tears were observed more often among women with TEH (P <0,05). Also, we observed only one TEH among the 25 women with caesarean section (4%). Finally, observation that TEH arise immediately after delivery is another argument to support the role of traumatic delivery. We also demonstrated the role of terminal constipation as risk factor for TEH after delivery. To conclude, 1/3 of pregnant women develop AF or TEH after delivery. These 2 pathologies are strongly correlated to terminal constipation. TEH seems equally furthered by traumatic delivery.