Fissure in Ano (Anal Fissure)

A painful linear ulcer at the margin of the anus. It appears as a crack or slit in the mucous membrane of the anus and is very painful and difficult to heal. (Dorland, 27th ed & Stedman, 25th ed)

Also Known As:

Networked: 404 relevant articles (80 outcomes, 112 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Pain (Aches)
2.	Headache (Headaches)
3.	Hemorrhoids
4.	Esophageal Achalasia (Megaesophagus)
5.	Constipation

Experts

1.	Brisinda, Giuseppe: 5 articles (11/2012 - 08/2003)
2.	Maria, Giorgio: 5 articles (11/2012 - 08/2003)
3.	Maria, G: 5 articles (06/2008 - 01/2000)
4.	Brisinda, G: 5 articles (06/2008 - 01/2000)
5.	Scholefield, J H: 5 articles (10/2005 - 09/2002)
6.	Sajid, M S: 4 articles (01/2013 - 01/2008)
7.	Baig, M K: 4 articles (01/2013 - 01/2008)
8.	Jones, O M: 4 articles (09/2011 - 11/2003)
9.	Jones, Oliver M: 4 articles (05/2007 - 04/2002)
10.	Schouten, W R: 4 articles (12/2005 - 09/2002)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Fissure in Ano:

1.	Botulinum Toxins (Botulinum Toxin)IBA 11/01/2003 - "Botulinum toxin is an effective treatment for anal fissure, though there is a lack of agreement over the optimal site for its injection. " 10/01/2015 - "Fissurectomy combined with high-dose botulinum toxin A is a safe, effective, and durable option for the management of chronic anal fissure and a promising alternative to surgical sphincterotomy." 10/01/2015 - "Fissurectomy Combined with High-Dose Botulinum Toxin Is a Safe and Effective Treatment for Chronic Anal Fissure and a Promising Alternative to Surgical Sphincterotomy." 02/01/2008 - "Fissurectomy and botulinum toxin injection for the treatment of chronic anal fissure in females seems to be effective in the medium-term but there is a high rate of late recurrence. " 10/01/2009 - "This pilot study attempted to examine whether botulinum toxin is also effective in paediatric cases of anal fissure, a treatment which not yet has been reported in the literature. "
2.	Nitroglycerin (Dynamite)FDA LinkGeneric 01/01/2014 - "This quasi-experimental study demonstrates that open partial lateral internal sphincterotomy is superior to topical 0.2% nitroglycerin application in the treatment of chronic anal fissure, with good symptomatic relief, high rate of healing, fewer side effects, and a very low rate of early continence disturbances." 08/01/2000 - "Internal sphincterotomy is superior to topical nitroglycerin 0.25 percent in the treatment of chronic anal fissure, with a high rate of healing, few side effects, and low risk of early incontinence. " 06/01/1996 - "Anal fissure can be successfully treated with 0.2 per cent glyceryl trinitrate ointment applied topically." 08/01/2000 - "Internal sphincterotomy is superior to topical nitroglycerin in the treatment of chronic anal fissure: results of a randomized, controlled trial by the Canadian Colorectal Surgical Trials Group." 04/01/2007 - "Lateral internal sphincterotomy is superior to topical nitroglycerin for healing chronic anal fissure and does not compromise long-term fecal continence: six-year follow-up of a multicenter, randomized, controlled trial."
3.	Diltiazem (Cardizem)FDA LinkGeneric 11/27/2012 - "Successful treatment of chronic anal fissure with topical diltiazem leads to improvement in health-related quality of life." 05/01/2003 - "Diltiazem and glyceryltrinitrate (GTN) were equally effective in healing anal fissure but the former resulted in fewer side-effects." 12/01/2011 - "On the basis of the above studies, it can be concluded that topical application of diltiazem is useful in the treatment of chronic anal fissure, but to fully establish its efficacy, larger prospective double-blind study is required in the near future." 11/01/2002 - "This study shows that topical 2% diltiazem is an effective and safe treatment for chronic anal fissure in patients who have failed topical 0.2% GTN. " 01/01/2013 - "The study analyzed clinical trials investigating the effectiveness of diltiazem (DTZ) and glyceryltrinitrate (GTN) for the nonsurgical management of chronic anal fissure (CAF). "
4.	Nifedipine (Adalat)FDA LinkGeneric 01/01/2006 - "We conclude that GTN ointment and oral nifedipine are equally effective in the treatment of chronic anal fissure." 06/01/2003 - "Nifedipine (administered orally or applied topically) has been effective for nonsurgical treatment of anal fissure. " 03/01/2006 - "The aim of this study was to compare the efficacy of the local application of 0.5% nifedipine ointment vs. lateral internal sphincterotomy in the healing of chronic anal fissure. " 08/01/1999 - "Results obtained were as follows: total remission from acute anal fissure was achieved after 21 days of therapy in 95 percent of the nifedipine-treated patients (P < 0.01), as opposed to 50 percent of the controls (P < 0.01), and previously elevated maximum resting anal pressures decreased from a mean value +/- standard deviation of 72.5 +/- 10.07 mmHg to 50.5 +/- 10.03 mmHg in the nifedipine group. " 08/01/1999 - "The aim was to test the efficacy of local application of nifedipine gel" in healing acute anal fissure by relaxing the internal anal sphincter. "
5.	Isosorbide Dinitrate (Isordil)FDA LinkGeneric 05/01/2001 - "Isosorbide dinitrate is an effective treatment for anal fissure, and is significantly better than placebo." 11/01/1998 - "A dose of 2.5 mg of isosorbide dinitrate caused a greater reduction in maximum anal resting pressure than a dose of 1.25 mg. Topical isosorbide dinitrate is an effective and safe treatment for chronic anal fissure. " 02/01/2012 - "In this study, the goal was to investigate the effects of various doses of isosorbide dinitrate on chronic anal fissure and their long-term effects. " 04/01/2004 - "Fifty-four patients with chronic anal fissure were randomized in a prospective trial to either sphincterotomy or local 0.2 percent isosorbide dinitrate. " 04/01/2004 - "Randomized, prospective trial comparing 0.2 percent isosorbide dinitrate ointment with sphincterotomy in treatment of chronic anal fissure: a two-year follow-up."
6.	Lidocaine (Xylocaine)FDA LinkGeneric 11/01/2002 - "The aim of this study was to test the efficacy of local application of nifedipine and lidocaine ointment in healing chronic anal fissure. " 12/01/2007 - "Comparison of topical glyceryl trinitrate with lignocaine ointment for treatment of anal fissure: a randomised controlled trial." 05/01/2004 - "Randomized, double-blind trial comparing topical nitroglycerine with xylocaine and Proctosedyl in idiopathic chronic anal fissure." 11/01/2002 - "Our study clearly demonstrates that the therapeutic use of topical nifedipine and lidocaine ointment should be extended to the conservative treatment of chronic anal fissure." 11/01/2002 - "Topical nifedipine with lidocaine ointment vs. active control for treatment of chronic anal fissure: results of a prospective, randomized, double-blind study."
7.	onabotulinumtoxinA (Botox)FDA Link 04/01/2002 - "Botox decreases resting anal pressure, has healing rates of approximately 80% at six months after injection in patients with chronic anal fissure, and has a better outcome than topic nitroglycerine. " 01/01/2015 - "This study was designed to evaluate the early results of the topical application of Hydrolyzed Hibiscus esculentus Extract 3% ointment (Myoxinol 3%), a novel local product with Botox-like activity, in the conservative treatment of chronic anal fissure (CAF). " 01/01/2013 - "Fourteen patients required surgery for anal fissure (Botox ± fissurectomy 8; LIS 6). " 01/01/2009 - "Botox for chronic anal fissure: is it useful? " 09/01/2007 - "Combined fissurectomy and Botox injection for chronic anal fissure is an excellent and safe procedure with low morbidity and a high healing rate."
8.	Calcium Channel Blockers (Blockers, Calcium Channel)IBA 04/01/2015 - "Calcium channel blockers have an excellent effectiveness in the conservative management of chronic anal fissure (CAF). " 10/01/2005 - "Nitro-containing drugs and organic calcium channel blockers are potent inhibitors of anal sphincter myogenic tone that may be used in combination to treat chronic anal fissure." 01/01/2012 - "Medical therapy for chronic anal fissure, currently consisting of topical glyceryl trinitrate, botulinum toxin injection or the topical calcium channel blockers nifedipine or diltiazem in acute and chronic fissure and fissure in children may be applied with a chance of cure that is marginally better than placebo. " 03/01/2005 - "When the conservative treatment of the chronic anal fissure (nitrates, topical calcium channel blockers, topical nifedipine, lignocaine and cortisone compounds) proves to be inefficient, the surgery may be opted for. " 01/01/2006 - "Eleven agents were used (nitroglycerin ointment (GTN), isosorbide dinitrate, Botulinum toxin (Botox), diltiazem, nifedipine (Calcium channel blockers or CCBs), hydrocortisone, lignocaine, bran, minoxidil, indoramin, and placebo) as well as anal dilators and surgical sphincterotomy.GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.6% vs. 37%, p < 0.004), but late recurrence of fissure was common, in the range of 50% of those initially cured. "
9.	Glycerol (Glycerine)FDA LinkGeneric 01/01/2009 - "The following conclusion was drawn topical Glycerol Trinitrate 0.2% ointment, applied twice a day during two weeks, is effective in the treatment of chronic anal fissure, with a 69.9% success rate after two months of follow-up. " 01/01/2009 - "[Use of glycerol trinitrate in an ointment for the management of chronic anal fissure at the National Hospital "Cayetano Heredia"]." 12/01/2006 - "A total of 48 patients suffering from chronic anal fissure were enrolled in this prospective, randomized study between January 2002 and December 2003: Group A, 16 patients were treated with 0.25 percent glycerin trinitrate ointment and also used cryothermal anal dilators; Group B, 16 patients were treated with 0.25 percent glycerin trinitrate ointment only; Group C, 16 patients were treated with cryothermal anal dilator use only. " 12/01/2006 - "Randomized, prospective trial comparing 0.25 percent glycerin trinitrate ointment and anal cryothermal dilators only with 0.25 percent glycerin trinitrate ointment and only with anal cryothermal dilators in the treatment of chronic anal fissure: a two-year follow-up." 06/01/2010 - "Initial treatment for anal fissure is with a high fibre diet, faecal softeners, topical local anaesthetic gel and glycerol trinitrate ointment. "
10.	Hydrocortisone (Cortisol)FDA LinkGeneric 05/03/1986 - "One hundred and three patients with an acute first episode of posterior anal fissure were randomised to receive a three week trial of lignocaine ointment (n = 33) versus hydrocortisone ointment (n = 35) or warm sitz baths combined with an intake of unprocessed bran (n =35). " 05/03/1986 - "Treatment of first episodes of acute anal fissure: prospective randomised study of lignocaine ointment versus hydrocortisone ointment or warm sitz baths plus bran." 04/01/2004 - "Twenty one different comparisons of medical therapies to heal anal fissure have been reported in 31 trials, including 9 agents-glyceryl trinitrate, isosorbide dinitrate, botulinum toxin, diltiazem, nifedipine, hydrocortisone, lidocaine, bran, placebo-as well as anal dilators and surgical sphincterotomy. " 01/01/2006 - "Eleven agents were used (nitroglycerin ointment (GTN), isosorbide dinitrate, Botulinum toxin (Botox), diltiazem, nifedipine (Calcium channel blockers or CCBs), hydrocortisone, lignocaine, bran, minoxidil, indoramin, and placebo) as well as anal dilators and surgical sphincterotomy.GTN was found to be marginally but significantly better than placebo in healing anal fissure (48.6% vs. 37%, p < 0.004), but late recurrence of fissure was common, in the range of 50% of those initially cured. "

Therapies and Procedures

1.	Local Anesthesia 09/01/2004 - "The aim of this prospective randomized trial was to compare the effectiveness and morbidity of open and closed sphincterotomy performed as an outpatient procedure under local anesthesia in the treatment of chronic anal fissure. " 09/01/2004 - "Open versus closed lateral sphincterotomy performed as an outpatient procedure under local anesthesia for chronic anal fissure: prospective randomized study of clinical and manometric longterm results." 12/01/2005 - ""Open" or "closed" lateral internal sphincterotomy performed in the ambulatory setting with local anesthesia can currently be considered the ideal treatment of chronic anal fissure refractory to conservative measures so long as the patient is informed about the risk of minor incontinence. " 12/01/2004 - "We carried out a prospective study of 120 patients operated on for chronic anal fissure with open sphincterotomy under local anesthesia at our Proctology Outpatient Unit from 1998 to 2001. " 01/01/2003 - "Beside hemoorhoides, methods that can be performed in local anesthesia in an outpatient institutions can be performed as well in cases of other benign conditions (such as lateral sphincterotomy in cases of anal fissure, fistulotomy and similar). "
2.	Injections 08/01/2002 - "The side effects of BT-A injections in the treatment of chronic anal fissure (105 patients) and functional outlet obstruction (34 patients) were analysed prospectively. " 08/01/1999 - "BoTx remains an effective treatment in recurring anal fissure as well as in patients with therapeutic failure of prior BoTx injections." 08/01/1963 - "[CASES OF SUCCESSFUL TREATMENT OF FISSURE IN ANO WITH PANCAL INJECTIONS]." 03/01/2005 - "Material consisted of 327 patients (F202, M125) who underwent 1043 sessions of BTX-A injections for: cervical dystonia--CD (n=58), blepharospasm--BLP (n=31), hemifacial spasm--HFS (n=39), spasticity due to cerebral palsy--CP (n=96), chronic anal fissure--CAF (n=96), esophageal achalasia--AE (n=7). " 01/01/2012 - "An answer was attempted to the following research questions: (i) what is the efficacy of botulinum toxin in healing of anal fissure compared to placebo, (ii) what is the efficacy of botulinum toxin in healing of anal fissure compared to other means of chemical sphincterotomy, (iii) what is the efficacy of botulinum toxin in healing of anal fissure compared to surgical sphincterotomy, (iv) what is the short term safety of botulinum toxin injections and (v) what is the long term safety of botulinum toxin injections. "
3.	Lasers (Laser) 01/01/1996 - "Microvascular perfusion of the anoderm was assessed by laser Doppler flowmetry in 27 patients with anal fissure. " 08/01/2015 - "This study revealed that this new laser-based surgery is a simple, safe, and effective procedure to treat the anal fissure that can be performed with local anesthesia in an outpatient clinic with minimal postoperative morbidity. " 02/01/1993 - "The authors studied the medico-economical data on the use of the laser techniques in the treatment of persisting wounds and trophic ulcers, cutaneous leishmaniasis, chronic anal fissure, purulent diseases of the soft tissues, epithelial coccygeal passage, ingrowing nail, and localized hyperkeratosis. "
4.	Transcutaneous Electric Nerve Stimulation (TENS) 11/01/2013 - "We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve. " 10/01/2015 - "Recurrence of anal fissure after one year was reported in one (2.7%) and 11 (40.7%) patients in lateral internal sphincterotomy and transcutaneous electrical nerve stimulation groups respectively. " 11/01/2013 - "Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality."
5.	Moxibustion 06/01/2013 - "Two hundred cases of postoperation of anal fissure were randomly divided into an acupuncture-moxibustion group and a medication group, 100 cases in each one. " 06/01/2013 - "[Influence of acupuncture and moxibustion on defecation in postoperative patients of anal fissure: a randomized controlled trial]." 06/01/2013 - "To verify the clinical efficacy of acupuncture and moxibustion on defecating and pain symptoms in postoperative patient of anal fissure. " 06/01/2013 - "The intervention treatment of acupuncture and moxibustion has clinical significance on relieving pain symptoms and improving defecation willingness in postoperative patient of anal fissure."