Management of Treatment and Diagnosis of Anal Fissures
Özet
Anal fissures are mucosal tears in the anoderm layer that cause severe pain and bleeding, categorized as acute if lasting less than six weeks and chronic if exceeding this duration. Affecting men and women equally, the pathophysiology of chronic fissures involves hypertonicity of the internal anal sphincter, which induces local ischemia and hinders natural healing. Diagnosis is predominantly established through clinical history and physical examination. Initial management focuses on symptomatic relief via warm sitz baths and dietary alterations, alongside pharmacological options for chemical sphincterotomy, such as topical nitrates, calcium channel blockers, and botulinum toxin injections to temporarily reduce sphincter tone. Minimally invasive modalities like endoscopic or balloon anal dilatation, autologous fat transplantation, and posterior tibial nerve stimulation have also emerged as viable non-surgical treatments. For refractory cases unresponsive to conservative therapies for over 6-8 weeks, surgical intervention becomes necessary, where lateral internal sphincterotomy remains the gold standard due to its high efficacy, despite a potential risk of fecal incontinence. Consequently, alternative surgical procedures with lower incontinence risks, including dermal advancement flaps and fissurectomy, serve as crucial therapeutic options depending on patient-specific sphincter pressure and continence status.
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