Anal fissure

Fissure-in-ano is a common condition causing considerable morbidity in a ge nerally young and otherwise healthy population. The use of pharmacological agents in the treatment of this condition, so-called chemical sphincterotom y, is increasing. Topical glyceryl trinitrate is now widely accepted as fir st-line therapy, and recent studies indicate that alternative drugs may be similarly efficacious but with fewer side effects. Botulinum toxin A inject ion has also been shown to be effective treatment but is more invasive, and its precise role in the management of fissure-in-ano remains uncertain. Tr aditional surgical treatments are associated with a risk for impaired anal continence but remain a valuable option where fissures either persist despi te pharmacological therapy or repeatedly recur. Where anal pressures are no t elevated in such patients, however, treatment with anal advancement flaps should be considered.