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Anal Fissure

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1. Anal fissure

Anal fissure Anal fissure - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Anal fissure Last reviewed: February 2019 Last updated: March 2018 Summary Causes severe pain on defecation, often described as 'like passing broken glass'. The pain may continue for 1 to 2 hours and can also be burning in nature. A small amount of fresh red blood is often passed on the stool. On examination of the anus, there is often marked (...) spasm of the sphincter muscles, with significant tenderness often precluding digital examination. Initial treatment should include either topical glyceryl trinitrate or diltiazem, along with a programme of supportive care. Resistant or chronic fissures may benefit from botulinum toxin A, and most cases can be cured by surgical sphincterotomy or anal advancement flap. Definition Anal fissure is a split in the skin of the distal anal canal characterised by pain on defecation and rectal bleeding

2018 BMJ Best Practice

3. Management of Anal Fissures

Management of Anal Fissures Copyright © The American Society of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. 7 Diseases of the Colon & ReCtum Volume 60: 1 (2017) t he a merican s ociety of Colon and Rectal surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention, and manage- ment of disorders and diseases of the colon, rectum, and anus. t he Clinical Practice Guidelines Committee is com- posed of society members (...) , Alexander-Williams J, Keighley MR. manual dilatation of the anus vs. lateral subcutaneous sphinc- terotomy in the treatment of chronic fissure-in-ano. Results of a prospective, randomized, clinical trial. Dis Colon Rectum. 1987;30:420–423. 50. Ram e, Vishne t , l erner i, Dreznik Z. a nal dilatation ver- sus left lateral sphincterotomy for chronic anal fissure: a prospective randomized study [published online ahead of print December 3 2007]. Tech Coloproctol. doi:10.1007/ s10151-007-0373-7. 51. Renzi

2017 American Society of Colon and Rectal Surgeons

4. Letter to the editor on "Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: A prospective randomised study". Our results in the patients who undergone to secondary healing following the fissure tract excisi Full Text available with Trip Pro

Letter to the editor on "Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: A prospective randomised study". Our results in the patients who undergone to secondary healing following the fissure tract excisi 29037883 2019 02 11 2019 02 15 0219-3108 40 6 2017 Nov Asian journal of surgery Asian J Surg Letter to the editor on "Open versus closed lateral internal anal sphincterotomy in the management of chronic anal fissures: A prospective randomised (...) study". Our results in the patients who undergone to secondary healing following the fissure tract excision for primary chronic anal fissure. 495-497 S1015-9584(17)30421-9 10.1016/j.asjsur.2017.09.002 Yücesoy Ali Naki AN General Surgery Department, Batı Bahat Hospital, Istanbul, Turkey. Electronic address: alinakiyucesoy@gmail.com. eng Letter 2017 10 14 China Asian J Surg 8900600 1015-9584 IM Adolescent Adult Anal Canal surgery Chronic Disease Debridement Dilatation methods Fecal Incontinence

2019 Asian Journal of Surgery

5. Chronic anal fissure: 2% topical diltiazem hydrochloride

and alternatives es Diltiazem hydrochloride is a calcium channel blocker and potent vasodilator. It increases blood flow to smooth muscles and relaxes muscle tone. Condition Anal fissure is a common and painful problem that involves a tear or ulcer in the squamous epithelium of the anus, usually located in the posterior midline. Anal fissure typically causes Chronic anal fissure: 2% topical diltiazem hydrochloride (ESUOM3) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk (...) Chronic anal fissure: 2% topical diltiazem hydrochloride Chronic anal fissure: 2% topical diltiazem Chronic anal fissure: 2% topical diltiazem h hy ydrochloride drochloride Evidence summary Published: 22 January 2013 nice.org.uk/guidance/esuom3 pathways K Ke ey points from the e y points from the evidence vidence The content of this evidence summary was up-to-date in January 2013. See summaries of product characteristics (SPCs), British national formulary (BNF), BNF for children (BNFc

2013 National Institute for Health and Clinical Excellence - Advice

6. Chronic anal fissure: botulinum toxin type A injection

Adults Anal fissure is a common and painful problem that involves a tear or ulcer in the squamous epithelium of the anus. It usually occurs between the ages of 20 and 40 with an equal distribution Chronic anal fissure: botulinum toxin type A injection (ESUOM14) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 34between men and women and a lifetime incidence of 11.1% (Cross et al. 2008). Most of the fissures (...) Chronic anal fissure: botulinum toxin type A injection Chronic anal fissure: botulinum to Chronic anal fissure: botulinum toxin type xin type A A injection injection Evidence summary Published: 25 June 2013 nice.org.uk/guidance/esuom14 pathways K Ke ey points from the e y points from the evidence vidence The content of this evidence summary was up-to-date in June 2013. See summaries of product characteristics (SPCs), British national formulary (BNF) or the MHRA or NICE websites for up- to-date

2013 National Institute for Health and Clinical Excellence - Advice

7. Chronic anal fissure: 0.2% topical glyceryl trinitrate ointment

Chronic anal fissure: 0.2% topical glyceryl trinitrate ointment Chronic anal fissure: 0.2% topical gly Chronic anal fissure: 0.2% topical glyceryl ceryl trinitr trinitrate ointment ate ointment Evidence summary Published: 26 March 2013 nice.org.uk/guidance/esuom7 pathways K Ke ey points from the e y points from the evidence vidence The content of this evidence summary was up-to-date in March 2013. See summaries of product characteristics (SPCs), British national formulary (BNF), BNF (...) for children (BNFc) or the MHRA or NICE websites for up-to-date information. Currently, 0.4% glyceryl trinitrate rectal ointment (Rectogesic 4 mg/g rectal ointment, ProStrakan) is the only licensed treatment for chronic anal fissure in the UK. It is indicated for the relief of pain associated with chronic anal fissure in adults, but is not licensed for children or young people under 18 years. T opical 0.2% glyceryl trinitrate ointment does not currently have a UK licence for treating chronic anal fissures

2013 National Institute for Health and Clinical Excellence - Advice

8. Topical Minoxidil Versus Topical Diltiazem for Chemical Sphincterotomy of Chronic Anal Fissure: A Prospective, Randomized, Double-Blind, Clinical Trial (Abstract)

Topical Minoxidil Versus Topical Diltiazem for Chemical Sphincterotomy of Chronic Anal Fissure: A Prospective, Randomized, Double-Blind, Clinical Trial Anal fissure is a common anorectal problem causing severe pain and discomfort to the patients. Chemical sphincterotomy has emerged as a noninvasive alternative to the surgical methods of fissure treatment. The objective of this study was evaluation of the efficacy and the adverse effects of topically applied minoxidil in chemical sphincterotomy (...) of chronic anal fissure in comparison with topical diltiazem.A total of 88 patients with chronic anal fissure aged between 15 and 65 years were included in this double-blind, randomized clinical trial and were randomly assigned to either 0.5% minoxidil cream or 2% diltiazem cream twice daily for 2 weeks. The pain intensity, bleeding, wound healing, itching, headache, dizziness, significant drop in blood pressure, allergy and fissure relapse were assessed on a monthly basis for 2 months.Both diltiazem

2018 EvidenceUpdates

9. Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. (Abstract)

Posterolateral versus lateral internal anal sphincterotomy in the treatment of chronic anal fissure: a randomized controlled trial. Lateral internal anal sphincterotomy (LIS) is considered the treatment of choice for chronic anal fissure. This study aimed to compare the outcome of standard LIS and posterolateral internal sphincterotomy (PLIS) at 5 o'clock position as regards healing of anal fissure, improvement in symptoms, and complications.Patients with chronic anal fissure were randomly (...) allocated to one of two groups; group I underwent PLIS and group II underwent LIS. Patients were compared regarding the duration of healing of anal fissure, improvement in anal pain as recorded by visual analogue scale (VAS), complications, particularly fecal incontinence (FI) and changes in the anal pressures.Eighty (49 females) patients were included to this trial. The mean age of patients was 35.5 years. The duration of healing was significantly shorter in group I than in group II (4.1 ± 1.7 vs 5.8

2018 International journal of colorectal disease Controlled trial quality: uncertain

10. Anal advancement flap versus lateral internal sphincterotomy for chronic anal fissure- a systematic review and meta-analysis. Full Text available with Trip Pro

Anal advancement flap versus lateral internal sphincterotomy for chronic anal fissure- a systematic review and meta-analysis. Chronic anal fissures (CAF) are common and associated with reduced quality of life. Lateral internal sphincterotomy (LIS) is frequently carried out but carries a significant risk of anal incontinence. Anal advancement flap (AAF) has been advocated as an alternative, 'sphincter-preserving' procedure. We aimed to perform a systematic review and meta-analysis to compare (...) the efficacy of both techniques in the treatment of CAF.The online databases of PubMed/Medline, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials were searched from inception to January 2017. All studies that investigated and reported outcomes of LIS and AAF for treatment of CAF were included. The primary outcome measure was anal incontinence while secondary outcomes included unhealed fissure and wound complication rates. Random effects models were used to calculate pooled effect size

2018 International journal of surgery (London, England)

11. Posterolateral Versus Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure

Posterolateral Versus Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure Posterolateral Versus Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before (...) adding more. Posterolateral Versus Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT03426449 Recruitment Status : Completed First Posted : February 8, 2018 Last Update Posted : February 9, 2018 Sponsor: Mansoura University Information

2018 Clinical Trials

12. Anal Fissure

Anal Fissure Anal Fissure in adults Anal Fissure in adults Anal Fissure in adults Anal Fissure in adults Management Management Management Management Options Options Options Options Brief Decision Aid Anal fissures are small tears of the skin of the anus, common in adults. Constipation and hard stools may cause them, and spasm of the anal muscles (sphincter) slows healing. Acute fissures have been present for less than six weeks; chronic fissures last longer than six weeks. There are three three (...) three three options in managing anal fissure: • General Measures General Measures General Measures General Measures – many fissures will heal on their own or with simple measures and ointments which ease the pain/inflammation and keep the faeces soft and easy to pass. • Calcium Channel Blocker and Nitrate ointment Calcium Channel Blocker and Nitrate ointment Calcium Channel Blocker and Nitrate ointment Calcium Channel Blocker and Nitrate ointments s s s - relax the muscles around the anus allowing

2015 SickKids Reports

13. Outcome Of 0.2% Glyceryltrinitrate Cream Versus 2% Diltiazem Cream In The Treatment Of Chronic Anal Fissure. (Abstract)

Outcome Of 0.2% Glyceryltrinitrate Cream Versus 2% Diltiazem Cream In The Treatment Of Chronic Anal Fissure. Anal fissure is a linear tear in the distal anal canal resulting from persistent hypertonia and spasm of the internal sphincter which results in mucosal ischemia. We have conducted a study in order to compare the outcome of 0.2% glyceryl trinitrate cream versus 2% diltiazem cream in the treatment of chronic anal fissure.This randomized controlled trial (RCT) was carried out (...) in the Department of Surgical "B" unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 15th June 2012 to 15th May 2015. One hundred and eighty-four patients who visited the outpatient department for the treatment of chronic anal fissure were included in the study. They were divided into two groups with 92 patients in each group. Patients in group "A" included those patients receiving topical glyceryl trinitrate and group "B" patients were those receiving topical diltiazem cream.Out of 184 patients 66.3

2019 Journal of Ayub Medical College, Abbottabad : JAMC Controlled trial quality: uncertain

14. Anal fissure

fissures are common. They mostly affect people aged 15–40 years but can occur at any age. Primary anal fissures are uncommon in elderly people and warrant further investigation for an underlying cause. Clinical features of anal fissure include anal pain with defecation (with or without bright red rectal bleeding) and anal spasm. External examination of the anus may reveal a linear split in the anal mucosa. Acute anal fissures are superficial with well-demarcated edges. Chronic anal fissures are wider (...) associated with spasm of the internal anal sphincter (IAS) and a resulting increased anal tone, the cause of which is debated. One theory suggests that the spasm and increased anal tone occur in response to pain from anal trauma (such as from passing hard stools). These lead to reduced blood flow and ischaemia, increased risk of tearing, and poor healing of a resulting fissure [ ; ; ; ]. Studies have shown a reduced blood flow in the posterior midline of the anus (where about 90% of anal fissures occur

2017 NICE Clinical Knowledge Summaries

15. Anal self-massage in the treatment of acute anal fissure: a randomized prospective study Full Text available with Trip Pro

Anal self-massage in the treatment of acute anal fissure: a randomized prospective study An anal fissure (AF) is a tear in the epithelial lining of the anal canal. This is a very common condition, but the choice of treatment is unclear. The use of anal dilators is effective, economic, and safe. The aim of the study was to compare the efficacy of two conservative treatments, the use of anal dilators or a finger for anal dilatation, in reducing anal pressure and resolving anal fissures.Fifty (...) of their anal fissures. A comparison between signs and symptoms reported by the patients in the two groups showed a statistically significant reduction in anal pain (group A, P=0.0001; group B, P=0.0001) and bleeding after defecation (group A, P=0.001, group B, P=0.001). At 6 months after treatment, a significantly greater reduction in anal pain was observed in Group A compared to Group B (P=0.02).The use of anal self-massage with a finger appears to induce a better resolution of acute anal fissure than do

2017 Annals of Gastroenterology Controlled trial quality: uncertain

16. A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure Full Text available with Trip Pro

A Case Series of Anal Carcinoma Misdiagnosed as Idiopathic Chronic Anal Fissure Chronic anal fissure is a linear ulcer in the anal canal that has not cicatrized for more than 8-12 weeks of treatment. Most anal fissures are idiopathic and are located in the posterior midline. Squamous cell carcinoma of the anus commonly presents as bleeding and anal pain. It may also present as a mass, nonhealing ulcer, itching, discharge, fecal incontinence and fistulae. Not uncommonly, small and early cancers (...) are misdiagnosed as benign anorectal disorders like anal fissures or hemorrhoids. The clinical suspicion of squamous cell carcinoma of the anus is of paramount importance in patients with nonhealing anal fissures, fissures in atypical positions or with indurated or ulcerated anal tags and in patients with risk factors for the development of anal squamous intraepithelial lesions that are precursors of invasive anal squamous cell carcinoma. The authors present 3 cases of squamous cell carcinoma of the anus

2016 GE Portuguese journal of gastroenterology

17. Lateral Anal Sphincterotomy for Chronic Anal Fissures- A Comparison of Outcomes and Complications under Local Anaesthesia Versus Spinal Anaesthesia Full Text available with Trip Pro

Lateral Anal Sphincterotomy for Chronic Anal Fissures- A Comparison of Outcomes and Complications under Local Anaesthesia Versus Spinal Anaesthesia Fissure-in-Ano is one of the common and most painful anorectal conditions encountered in surgical practice. Inspite of several conservative treatment options, surgical treatment in the form of Lateral Anal Spincterotomy (LAS) remains the gold standard of treatment for Chronic Anal Fissures (CAF). However, LAS is often done under spinal or general (...) anaesthesia incurring huge treatment costs and hospital stay.To study if LAS can be treated with Local Anaesthesia (LA) thereby, reducing the costs and the anaesthetic risk to patients with no significant change in the surgical ease or clinical outcome.A total of 79 patients with chronic fissure underwent randomized allocation to two treatment arms - The first to undergo LAS under LA and the second under Spinal Anaesthesia (SA). The primary outcome variables studied were complications like post-operative

2017 Journal of clinical and diagnostic research : JCDR Controlled trial quality: uncertain

18. Comparison of Flavonoids and Centella asiatica for the treatment of chronic anal fissure. A randomized clinical trial. (Abstract)

Comparison of Flavonoids and Centella asiatica for the treatment of chronic anal fissure. A randomized clinical trial. We aim to test and compare the effects of Flavonoids (Fs) and Centella asiatica (Ca), and the traditional treatment to find out which best deals with healing time, bleeding and pain in the treatment of chronic Anal Fissure (AF). Materials of Study: 98 outpatients were divided randomly into treated (either Fs or Ca) and control group. The control group (Group C, n=32) received (...) with patients underwent to the traditional treatment.Anal bleeding, Anal fissure, Defecation pain.

2018 Annali italiani di chirurgia Controlled trial quality: uncertain

19. [Acupoint catgut embedding therapy in treatment of anal fissure at â…  and â…¡ stages:a randomized controlled trial]. (Abstract)

[Acupoint catgut embedding therapy in treatment of anal fissure at â…  and â…¡ stages:a randomized controlled trial]. To evaluate the difference in the clinical therapeutic effects on anal fissure at Ⅰ and Ⅱ stages between the acupoint catgut embedding therapy and western medication.Sixty patients of anal fissure at Ⅰ and Ⅱ stages were randomized into an embedding therapy group and a western medication group, 30 cases in each one. In the embedding therapy group, the acupoint catgut embedding (...) weeks after treatment, the clinical therapeutic effects in the embedding therapy group were better than those in the western medication group (both P<0.05). In 3-month follow-up, the recurrent case in the embedding therapy group was one, and the recurrent case in the western medication group was six.The acupoint catgut embedding therapy is safe and effective in the treatment of anal fissure at Ⅰ and Ⅱ stages and its recurrent case is lower as compared with the treatment of western medication.

2018 Zhongguo zhen jiu = Chinese acupuncture & moxibustion Controlled trial quality: uncertain

20. Could local antibiotics be included in the treatment of acute anal fissure? Full Text available with Trip Pro

Could local antibiotics be included in the treatment of acute anal fissure? Acute anal fissure is a very common disorder of the anorectal region. Its most widely used treatment method is the medications given in addition to conservative therapies. The objective of the present study was to investigate the effects of local metronidazole use in the treatment of acute anal fissure on the symptoms and remission processes of the patients.This was a prospective, randomized, controlled clinical study (...) conducted on 100 consecutive patients who presented to our clinic between March 2016 and March 2017 and who were diagnosed with acute anal fissure. Patients were randomly divided into two groups of 50 persons. Patients in Group 1 were given only 5% lidocaine pomade as a local anesthesia, and those in Group 2 were given 5% lidocaine pomade and metronidazole cream. Patients applied the medications topically to the anal margin 3 times per day for 4 weeks. Patients' demographic characteristics, such as age

2018 Turkish Journal of Surgery Controlled trial quality: uncertain

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