gastrointestinal disorders
Anal Fissure
Treatment of Anal Fissure
Stool softeners, fiber supplements Protective ointments, sitz baths Nitroglycerinointment, topical calcium channel blocker, or botulinum toxin type A injection (See also the American Society of Colon and Rectal Surgeons’2016 clinical practice guidelinefor the management of anal fissures.) Fissures often respond to conservative measures that minimize trauma during defecation (eg, stool softeners,psyllium, fiber). Healing is aided by use of protectivezinc oxideointments or bland suppositories (eg,glycerin) that lubricate the lower rectum and soften stool. Topical anesthetics (eg,benzocaine,lidocaine) and warm (not hot) sitz baths for 10 or 15 minutes after each bowel movement and as needed give temporary relief. Topicalnitroglycerin0.2% ointment,nifedipine0.2% cream, anddiltiazem2% gel or injections of botulinum toxin type A into the internal sphincter relax the anal sphincter and decrease maximum anal resting pressure, allowing healing. When conservative measures fail, surgery (internal anal sphincterotomy) is needed to interfere with the cycle of internal anal sphincter spasm. 