Geometry.Net - Health_Conditions: Anal Fissures

ASCRS: Anal Fissure
page for those seeking more information on anal fissures. Since hemorrhoids often appear to happen with anal fissures,
http://www.fascrs.org/brochures/anal-fissure.html

Extractions: Figure 1. A simple acute fissure, transanal view. The typical symptoms of an anal fissure are extreme pain during defecation and red blood streaking the stool. Patients may try to avoid defecation because of the pain. A hard, dry bowel movement can cause a tear in the anal lining, resulting in a fissure. Other causes of a fissure include diarrhea and inflammation of the anorectal area. Anal fissures may be acute (recent onset) or chronic (present for a long time or recurring frequently). An acute fissure is usually due to altered bowel habits while a chronic fissure may be either due to poor bowel habits, overly tight or spastic anal sphincter muscles, scarring or an underlying medical problem. An acute fissure is managed with non-operative treatments and over 90% will heal without surgery. Bowel habits are improved with a high fiber diet, bulking agents (fiber supplements), stool softeners, and plenty of fluids to avoid constipation and promote the passage of soft stools. Warm baths for 10-20 minutes several times each day are soothing and promote relaxation of the anal muscles. Occasionally, special medicated creams may be recommended. A chronic fissure (lasting greater than one month) may require additional treatment. Depending on the appearance of the fissure, other medical problems such as inflammatory bowel disease or infections may be considered and testing may be recommended. A manometry test may be performed to determine if anal sphincter pressures are high. An examination under anesthesia may be recommended to determine if a definite reason exists for lack of healing.
Treatment Of Anal Fissures
anal fissures originally are a superficial tear in the tissue which lines the anal canal.
http://www.gastromd.com/education/print_treatmentanalfissures.html

Extractions: Back Anal fissures originally are a superficial tear in the tissue which lines the anal canal. This superficial tear may deepen and eventually reach the underlying tissues. These tissues are the internal sphincter. With exposure to chronic irritation, the internal sphincter's function may become compromised, Subsequently, sentinel tags, hypertrophied anal papilla and anal stenosis may occur. Most patients with anal fissures relate pain with evacuation, rectal bleeding, itching, swelling and anal discharge. History is usually sufficient for the initial diagnosis. Eventually, further evaluation with palpation (rectal exam) and an endoscopic evaluation are useful. The etiology of an anal fissure may be associated with constipation, diarrhea, rubber band ligation for hemorrhoids or injection of the anal area. Other diseases such as chlamydia, gonorrhea, herpes, syphilis, AIDS, neoplasms, tuberculosis, and Crohn's disease may also present as anal fissures. A gastrointestinal work-up for these diseases is based upon the patient's presentation and clinical history. Treatment of anal fissures is divided into medical and surgical groups. Medical treatment of acute fissures is based upon topical creams, sitz baths, perirectal hygiene and dietary changes consisting of increasing fiber content.
Topical Treatment Of Chronic Anal Fissures
Topical treatment of chronic anal fissures. Reference. Lund JN, Scholefield JH.
http://www.infopoems.com/POEMs/JC049707.htm

Extractions: Reference Lund JN, Scholefield JH. A randomised, prospective, double-blind, placebo-controlled trial of glyceryl trinitrate ointment in treatment of anal fissure. Lancet 1997; 349:11-14. Reviewed by William F. Miser, MD Clinical question Can the topical application of glyceryl trinitrate ointment effectively treat chronic anal fissures? Background Chronic anal fissures, manifested by pain on defecation, rectal bleeding, and spasm of the internal anal sphincter, are difficult to treat. Until now, the only available treatment was surgicalsphincterotomy. While effective, this procedure is complicated by impairment of continence in up to 30% of cases. This study evaluated the efficacy of chemical sphincterotomy using topical 0.2% glyceryl trinitrate ointment (GTN). Population studied The study sample consisted of 80 consecutive men and women presenting to two surgical outpatient clinics in the United Kingdom. Eligible patients had symptoms of an anal fissure for over six weeks and evidence of fibrosis at the base of the fissure. Patients had a median age of 32.5 to 36 years, and a median duration of symptoms of 9 to 12 months. Ten patients had prior surgical correction of this problem. Study design and validity Outcomes measured The primary outcomes measured were healing of the anal fissure by eight weeks of treatment and pain on defecation.
Anal Fissures
How are anal fissures initially treated nonsurgically?
http://www.milsbrooklyn.com/colo_rectal/conditions/anal_fissures.html

Extractions: Despite applying the treatments described above, some fissures do not heal. The most common reason for delayed healing is scarring or muscle spasm of the anal sphincter muscle. Those fissures that do not heal can be corrected by cutting a portion of the muscle, a procedure called lateral internal sphincterotomy. This procedure involves cutting a portion of the internal anal sphincter muscle. This allows the fissure to heal by preventing pain and spasm. Cutting this muscle rarely interferes with the ability to control bowel movements and can be performed as an ambulatory procedure Back to top
ASCRS Practice Parameters For The Management Of Anal Fissure
present or there is a need for biopsy.(33) It may be necessary to create mucosalor skin advancement flaps in patients with broad anal fissures associated with
http://www.fascrs.org/ascrspp-moaf.html

Extractions: Drs. Lester Rosen, Chairman; Michael E. Abel, Co-Chairman; Philip H. Gordon, Council Member; Frederick J. Denstman, James W. Fleshman, Terry C. Hicks, Philip J. Huber, Harold L. Kennedy, Stuart E. Levin, John D. Nicholson, Jon F. Nicosia, Gregory C. Oliver, Patricia L. Roberts, Howard D. Robertson, David A. Rothenberger, James A. Surrell, Steven D. Wexner. It should be recognized that these guidelines should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all of the circumstances presented by the individual patient Practice parameters outline principles and provide suggestions to assist physicians in the care of patients with anal fissure. These principles should provide a rational basis for objective evaluations of patients by physicians and third-party payers. Such evaluations may make routine second opinions unnecessary. These parameters are forged from divergent opinions based on data from published articles including those on controlled trials in refereed journals, textbooks, the collective experiences of clinicians, and the opinions of members of the Standards Task Force. All parameters are reviewed carefully by the Executive Council of the American Society of Colon and Rectal Surgeons prior to adoption and will be reviewed periodically and amended as necessary.
Anal Fissures Resources On The Internet
Search millions of published articles for news on anal fissures. The eLibrary newspaper and magazine archive contains
http://www.healthcyclopedia.com/anal_fissures.html

Extractions: The eLibrary newspaper and magazine archive contains articles from current and back issues of hundreds of publications, including: Modern Medicine Aging The Ardell Wellness Report HealthFacts The Journal of Environmental Health Medical Post Medical Update Men's Health and the National Women's Health Report
Anal Fissure Self Help Page
Self help page for those seeking more information on anal fissures. Since hemorrhoidsoften appear to happen with anal fissures, I talk about them too.
http://boardsailor.com/jack/af/

Extractions: Anal Fissure Self Help Page This is a self help page for those seeking more information on anal fissures. Since hemorrhoids often appear to happen with anal fissures, I talk about them too. My goal is to help others by providing information on these ailments. I had an anal fissure and was in a lot of pain and did a web search only to find two pages that dealt with anal fissures and I wished there were more. I appreciated reading Joe's saga. I especially liked the last few paragraphs where he said that his fissure receded into oblivion in the two weeks following surgery. I think my self help pages are like an anonymous self help group. It is obvious from the many hits my pages are receiving that they are filling a need. Many of the hits are from searches on "anal + fissure" so people are looking for these pages when they find them. If you would like to contribute anything from a patient or physicians perspective, please do (I will keep your name off of any material you give me unless you want it on the material). Isn't this embarrassing?
Anal Fissure Self Help Page
Self Help page for those with anal fissures.
http://www.boardsailor.com/jack/af/index.html

Extractions: Anal Fissure Self Help Page This is a self help page for those seeking more information on anal fissures. Since hemorrhoids often appear to happen with anal fissures, I talk about them too. My goal is to help others by providing information on these ailments. I had an anal fissure and was in a lot of pain and did a web search only to find two pages that dealt with anal fissures and I wished there were more. I appreciated reading Joe's saga. I especially liked the last few paragraphs where he said that his fissure receded into oblivion in the two weeks following surgery. I think my self help pages are like an anonymous self help group. It is obvious from the many hits my pages are receiving that they are filling a need. Many of the hits are from searches on "anal + fissure" so people are looking for these pages when they find them. If you would like to contribute anything from a patient or physicians perspective, please do (I will keep your name off of any material you give me unless you want it on the material). Isn't this embarrassing?
0.2% Nitroglycerin Ointment
Management of anal fissures. Stephen Patients with anal fissures usuallypresent with minor anal bleeding and severe anal pain. The
http://boardsailor.com/jack/af/gorfine_paper.html

Extractions: An anal fissure is a linear crack or tear in the distal anoderm. Patients with anal fissures usually present with minor anal bleeding and severe anal pain. The etiology of anal fissures is not known with certainty, however, a considerable body of evidence now suggests an association between abnormal internal anal sphincter (IAS) function and anal fissures. Many studies have documented elevated resting anal pressures in fissure patients.(1,2) It is probable that an abnormal pressure response of the IAS plays a role in the causation of these lesions. Many acute fissures resolve with conservative treatment, however, fissures which become chronic usually require surgical therapy. The Standards Task Force of the American Society of Colon and Rectal Surgeons recommends management of chronic anal fissures by "subcutaneous or open lateral internal sphincterotomy, posterior internal sphincterotomy with advancement flap, or manual dilatation".(3) Healing will occur following sphincterotomy in 95 percent of cases.(4) Successful sphincterotomy (or anal dilatation) is associated with a significant decrease in intra-anal pressure.(5,6) Although sphicterotomy is quite effective in promoting healing of anal fissures, it is not without risk. Many studies have demonstrated complications, most notably, temporary or permanent incontinence to gas, liquid and solid stool following sphincterotomy or anal dilatation.(7,8)
Anal Fissures
anal fissures Guide picks. Fissures Anal fissure WebMD A short amountof information on fissures, but includes a diagram. Anal
http://ibscrohns.about.com/cs/fissures/
Anal Fissures Frequently Asked Questions
anal fissures FAQ. They're painful and embarassing but if you have one you'llneed treatment. Chronic use of laxatives; Anal sex. How are fissures treated?
http://ibscrohns.about.com/library/weekly/aa013102a.htm

Extractions: What is a fissure? A fissure is a tear or ulcer in the lining of the anal canal. The anal canal is the last part of the rectum before the anus. Fissures can occur in anyone, but are more common in middle age or young adults. A fissure can be difficult to heal as it causes a spasm in the anal sphincter and aggravates itself. What are the symptoms?
Cellegy Pharmaceuticals: Clinical: Anal Fissures
Anal fissure patients wanted for clinical trial Non-surgical treatmentfor anal fissures. What are anal fissures? An anal fissure
http://www.cellegy.com/clinical/anal_fissures.html

Extractions: An anal fissure is a tear in the lining of the anus that is associated with pain (especially during bowel movements), bleeding, and/or itching. While the exact cause of anal fissures is unknown, there is accumulating evidence that increased muscle tone (hypertonicity) of the internal, but not the external, anal sphincter is a predisposing factor in the formation of anal fissures, and possibly hemorrhoids. Blood vessels normally provide an adequate blood supply to the site where fissures occur. When sphincter tone is increased, the blood supply to the affected area is decreased and even minimal trauma, such as a hard stool, may increase the susceptibility to a fissure. In the US, approximately 235,000 anal fissures are diagnosed each year. About 60% of these fissures are acute and heal with conservative treatment. Stool softeners, topical anesthetics, sitz baths, and increased intake of dietary fiber are recommended to relieve pain, and prevent recurrence of the fissures. Anal fissures that do not heal within several weeks are considered chronic. Historically, chronic anal fissures have been treated surgically with a lateral internal anal sphincterotomy, in which the internal anal sphincter (IAS) is partially cut. While severing the IAS has been shown to promote the healing of a large percentage of chronic fissures, it has also been found to create some form of fecal incontinence in up to 35% of patients receiving this surgical treatment.
Worldbook Medical Encyclopedia > Abdomen - Azotemia > Anal Fissure
A comprehensive look at the topic Anal fissure patients suffering from chronic anal fissure Rome. anal fissures are cracks
http://www.s-books.com/wbmedical/30000/30117/3.htm

Extractions: Documents 21 - 30 of 47 on the subject : Anal fissure Public Educational Sources News and Magazines Encyclopedias HealthCentral.com - News - Botulinum Toxins Treats Anal Fissure - (1/21/1998) Botulinum Toxins Treats Anal Fissure - (1/21/1998)... internal anal sphincter may serve... chronic anal fissure,... patients suffering from chronic anal fissure,... Rome. Anal fissures are cracks... cracks or tears in the lower... 15 treated patients showed signs of anal... Botulinum Toxins Treats Anal Fissure January... suffering from chronic anal fissure,... Rome. Anal fissures are cracks... slow healing in chronic cases. Surgical sphincterotomy... Centers Most fissures will mend... ASCRS - Core Subjects: Fissure Pruritus ANAL FISSURE Anal fissure... tear in the anal canal extending... FISSURE Anal fissure is a tear... acquire features of chronicity, including a distal... 90% of anal fissures are located... anal sphincter. Topical application of nitroglycerin,... weeks. Stool softeners and fibre supplements... fissure is a tear in the anal... large hard stool. The proposed explanation... inferior rectal artery show compromised blood flow... anaesthetic and steroid ointments, dilators, and local... anal papilla, fibrotic edges, and exposed internal...
Cellegy Pharmaceuticals: Products: Anogesic Product Sheet
Product Background. Anogesic was invented by a prominent colorectal surgeonas a treatment for anal fissures and hemorrhoids. anal fissures.
http://www.cellegy.com/products/anogesic.html

Extractions: Product Background Clinical/Regulatory Status Anal Fissures Hemorrhoids ... Commercial Strategy Product Background Anogesic was invented by a prominent colorectal surgeon as a treatment for anal fissures and hemorrhoids. Anogesic consists of a proprietary formulation of nitroglycerin, a drug that has been used in the treatment of certain cardiovascular diseases for over a century. Nitroglycerin, a potent dilator of blood vessels, relaxes the internal sphincter muscle restoring normal blood flow to the anal tissue. This effect promoted healing of anal fissures in several studies conducted to date, two of which were published in The New England Journal of Medicine and The Lancet. These publications demonstrate that use of nitroglycerin ointment promotes healing of chronic anal fissures, offers significant pain reduction and eliminates the need for surgery in many cases.
Treatment Of Anal Fissures
Print this page anal fissures originally are a superficial tear inthe tissue which lines the anal canal. This superficial tear
http://www.gastromd.com/education/treatmentanalfissures.html

Extractions: Print this page Anal fissures originally are a superficial tear in the tissue which lines the anal canal. This superficial tear may deepen and eventually reach the underlying tissues. These tissues are the internal sphincter. With exposure to chronic irritation, the internal sphincter's function may become compromised, Subsequently, sentinel tags, hypertrophied anal papilla and anal stenosis may occur. Most patients with anal fissures relate pain with evacuation, rectal bleeding, itching, swelling and anal discharge. History is usually sufficient for the initial diagnosis. Eventually, further evaluation with palpation (rectal exam) and an endoscopic evaluation are useful. The etiology of an anal fissure may be associated with constipation, diarrhea, rubber band ligation for hemorrhoids or injection of the anal area. Other diseases such as chlamydia, gonorrhea, herpes, syphilis, AIDS, neoplasms, tuberculosis, and Crohn's disease may also present as anal fissures. A gastrointestinal work-up for these diseases is based upon the patient's presentation and clinical history. Treatment of anal fissures is divided into medical and surgical groups. Medical treatment of acute fissures is based upon topical creams, sitz baths, perirectal hygiene and dietary changes consisting of increasing fiber content.
FamilyFun: Health Encyclopedia: Anal Fissures
anal fissures, anal fissures can be treated successfully and seldom becomechronic. WHEN SHOULD I SUSPECT THAT MY CHILD HAS anal fissures?
http://familyfun.go.com/raisingkids/child/health/childhealth/dony79enc_anfiss/do

Extractions: A small tear or cracklike sore in the mucous lining of the anus, the outlet through which fecal waste passes, is known as an anal fissure. Fissures are the most common cause of rectal bleeding in infants and older children. While parents may be alarmed to see a blood stain in their child's stool or diaper, there is usually no need for concern. Anal fissures can be treated successfully and seldom become chronic. WHEN SHOULD I SUSPECT THAT MY CHILD HAS ANAL FISSURES?
Anal Dilatation For Anal Fissures
Anal Dilatation for anal fissures. Norman Sohn and Michael A. Weinstein. Sohn,N and Weinstein, MA Anal Dilatation for anal fissures.
http://ssamed.com/anal_dilatation_for_anal_fissure-paper.htm

Extractions: S O M E R S E T S U R G I C A L A S S O C I A T E S, P.C. Norman Sohn MD, FACS, FASCRS, Michael Weinstein MD, FACS, FASCRS Jeffrey Aronoff MD,FACS, FASCRS Frank Cohen MD, FACS Joseph Martz MD 475 East 72nd Street, New York, NY 10021 Phone Fax (212) 794 - 2168 Directions to Somerset Surgical Associates PC E-mail somerset@ssamed.com PAPERS AND PRESENTATIONS FROM SOMERSET SURGICAL STAFF Anorectal Physiology Laboratory Anorectal Manometry PNTML Testing Neuromuscular Re-Education/ Bowel Management for Incontinence and Constipation ... Abnormal Manometric Parameters Useful Links American Society of Colon and Rectal Surgeons genetic testing for hereditary colorectal cancer (mYRIAD GENETIC LABORATORIES) The International Foundation for Bowel Dysfunction ... PubMed Anal Dilatation for Anal Fissures Norman Sohn and Michael A. Weinstein From the Department of Surgery, Lenox Hill Hospital, New York, NY and the Departments of Surgery of Cornell Medical School and New York University School of Medicine.
New Page 2
The precise cause of anal fissures is unknown. BOTULINUM TOXIN. Botulinumtoxin has recently been recommended for anal fissures.
http://ssamed.com/new_page_2.htm

Extractions: S O M E R S E T S U R G I C A L A S S O C I A T E S, P.C. Norman Sohn MD, FACS, FASCRS, Michael Weinstein MD, FACS, FASCRS Jeffrey Aronoff MD,FACS, FASCRS Frank Cohen MD, FACS Joseph Martz MD 475 East 72nd Street, New York, NY 10021 Phone Fax (212) 794 - 2168 Directions to Somerset Surgical Associates PC E-mail somerset@ssamed.com PAPERS AND PRESENTATIONS FROM SOMERSET SURGICAL STAFF Anorectal Physiology Laboratory Anorectal Manometry PNTML Testing Neuromuscular Re-Education/ Bowel Management for Incontinence and Constipation ... Abnormal Manometric Parameters Useful Links American Society of Colon and Rectal Surgeons genetic testing for hereditary colorectal cancer (mYRIAD GENETIC LABORATORIES) The International Foundation for Bowel Dysfunction ... PubMed ANAL FISSURE IMPORTANT ASPIRIN WARNING DISCONTINUE ANY ASPIRIN OR ASPIRIN RELATED PRODUCTS 7 DAYS PRIOR TO YOUR SCHEDULED COLONOSCOPY OR ANY OTHER SCHEDULED PROCEDURE An anal fissure is a split or tear in the lining of the lower rectum. It can cause pain or bleeding, usually with defecation. The pain typically occurs with or directly follows defecation, persists for several minutes to several hours and then subsides only to recur with the next bowel movement. In some cases the pain can be continuous and intensely severe.
Addenbrooke's NHS Trust: FAQs About Anal Fissures
Frequently asked questions (FAQs) about anal fissures. anal fissures aredifferent from haemorrhoids and have no relationship with cancer.
http://www.addenbrookes.org.uk/serv/clin/surg/colorectal/fissure1.html

Extractions: An anal fissure is a split in the skin at the opening of the anus, which leaves exposed some of the muscle fibres of the anal canal. Pain results from the recurrent opening of the wound when the bowels are opened, and it is often accompanied by bleeding. In addition, the inner circle of muscle in the anal canal (called the internal sphincter) goes into spasm: this makes the pain worse and can prevent healing. Anal fissures are different from haemorrhoids and have no relationship with cancer. What are the symptoms of an anal fissure? What are the treatments for an anal fissure?
Addenbrooke's NHS Trust: FAQs About Surgery For Anal Fissures (internal Sphincte
Frequently asked questions (FAQs) about surgery for anal fissures (internalsphincterotomy). Why is surgery necessary for anal fissures?
http://www.addenbrookes.org.uk/serv/clin/surg/colorectal/internsphinct1.html

Extractions: A fissure is a split in the skin at the opening of the anus, which leaves exposed some of the muscle fibres of the anal canal. Pain results from the recurrent opening of the wound when the bowels are opened and it is often accompanied by bleeding. In addition, the inner circle of muscle in the anal canal (called the internal sphincter) goes into spasm: this makes the pain worse and can prevent healing. Why is surgery necessary for anal fissures? The operation to treat anal fissures is called an internal sphincterotomy . It involves that a part of the internal sphincter muscle being cut. The cut relieves the tension of the muscle and allows the fissure to heal. Occasionally, a polyp can develop at the edge of a long-standing fissure, and this might be removed at the same time. It is not usually necessary to remove or suture the fissure itself. What can go wrong?

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