ETIOLOGY AND TREATMENT OF ANAL-FISSURE

Anal fissure is a common problem that causes significant morbidity in a young and otherwise healthy population. Treatment has remained large ly unchanged for over 150 years and the pathogenesis of this condition is not yet fully explained. Acute fissures should be treated conserva tively with dietary modification. Chronic fissures do not respond to c onservative treatment. The current recommended surgical treatment for chronic fissure is lateral internal sphincterotomy. However, there is a disturbance of continence in a sizeable proportion of those undergoi ng this procedure. As yet there is no proven non-surgical treatment fo r chronic fissure. Although local injection of botulinum toxin and the topical application of nitrates show early promise, further controlle d trials are needed.