Fissures are a small split or tear in the skin. Anal fissures are small splits or tears in the mucosal lining of the lower rectum and can range from involving only the epithelium to encompassing the entire thickness of the anal mucosa. Anal fissures can be acute or chronic. The goal of treatment is to relieve pain, constipation , and spasms, as well as reduce the resting internal anal sphincter pressure so that the fissure can fully heal. Therapy for anal fissures ranges from conservative measures to pharmacologic treatments to surgical interventions.
Internal anal sphincter
Internal anal sphincter - Wikipedia
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Digital rectal examination DRE is part of the physical examination, is also essential for the colorectal surgeon evaluation. It is simple, quick and minimally invasive. On the other hand, anorectal manometry ARM is the main method for objective functional evaluation of anal sphincter pressures. The discrepancy of DRE depending on the examiner to determine sphincter tonus in comparison to ARM motivated this study.
Anal fissure fissure-in-ano is a very common anorectal condition. The exact etiology of this condition is debated; however, there is a clear association with elevated internal anal sphincter pressures. Though hard bowel movements are implicated in fissure etiology, they are not universally present in patients with anal fissures. Half of all patients with fissures heal with nonoperative management such as high fiber diet, sitz baths, and pharmacological agents.