[Fistulas and fissures. Part II: fissures]

Abstract

Fissures in ano are linear ulcers situated in the anal canal and extending from the dentate line to the margin of the anus. They cause pain and spasms. Diagnosis is made by the history alone. Local medical treatment might consist of topical 0.4% glycerol trinitrate or 2% calcium blocker. In case of therapy resistance, botulinum toxin injection into the internal sphincter is an effective but expensive alternative with encouraging results. If medical treatment fails, then operation has to be recommended. As lateral internal sphincterotomy represents poses a clear danger to continence, fissurectomy combined with the excision of skin tags and any anal papilla is now the operative treatment of choice.