The American Gastroenterological As...

The American Gastroenterological Association (AGA) has released a technical review forward diagnosis and care of patients with anal fissure. "AGA Technical Review upon the Diagnosis and Care of Patients with Anal Fissure" appears in the January 2003 issue of Gastroenterology and is available online at http://www.gastro. org.

Anal fissure is a general disorder but often is misdiagnosed as hemorrhoids. Its exact incidence and cause are unknown. Standard treatment traditionally has included fiber supplementation, sitz baths, and topical analgesics. However, this approach newly has been modified to include of recent origin treatment options.

Young adults are greatest in quantity frequently affected. The majority of fissures offer in the posterior midline, although anterior midline fissures come about in 25 percent of affected women and 8 percent of affected men Physical examination confirms the diagnosis. most numerous fissures are best seen according to separating the buttocks with opposing traction. A sentinel skin tag should alert the examiner to the likely personality of a fissure. Digital and endoscopic examinations are not appropriate in patients with marked tendernes because these classifications are traumatic to the patient and rarely yield diagnostic information. When significant anal pain cannot be diagnosed comfortably, examination beneath anesthesia is warranted.

Anal fissure is associated with elevated resting anal hurry and therapy is directed at reducing anal tone. About single in kind half of patients who receive standard conservative care will be healed. Preliminary reports of of the present day treatments such as topical sphincter relaxants and locally injected botulinum toxin are promising, although a certain quantity of topical agents are not to this time available commercially in the United States. Surgery is a highly lucky treatment option; virtually all U adroits advocate lateral internal sphincterotomy (LIS) for patients with anal fissure. However, LIS has been associated with minor incontinence in about patients.

COPYRIGHT 2004 American Academy of Family Physicians

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