Modern Therapeutic Approaches to the Treatment of Anal Fissure

Abstract

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov

Anal fissure (AF) is one of the most common coloproctological diseases which causes reduction in quality of life. The incidence of anal fissure is 2,1 - 2,3% or 21-23 cases per 1000 working-age people in Russian Federation. Fissures occur most frequently in the posterior midline of the anal canal and associated with the poor blood supply to this area. In some cases, AFs are seen in the anterior midline and rarely seen laterally in the anal. The exact etiology of anal fissures is not entirely clear. However, there is a clear association with the increased pressure within the anal canal. Anal fissures may be acute and chronic. Up to 87% of AFs are resolved with conservative management which includes sitz baths, laxatives, increased intake of fluid and fiber. Patients with chronic anal fissures require the addition of medical treatment. First line therapy includes application of calcium channel blockers (CCB) or topical nitrates in addition to increasing dietary fiber. Medical management is usually effective in 65-95%. However, the range of worldwide approved drugs containing CCBs ornitrates is still very poor. If fissures do not resolve after 6-8 weeks of first line therapy, referral to secondary care (botulinum toxin injections and surgical sphincterotomy) is made. The healing rate in case lateral internal sphincterotomy is close to 100%, however, the fecal incontinence rate ranges from 8% to 30%. In this regard, the development of new effective drugs with the minimum side effects is still a critical task.