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The name of the condition comes from the clinical picture related to ulcers, and is not related to its appearance. The anal fissure is fissure-shaped only when the anal muscles are tensed. It usually runs from the pectineal line to the anal verge. In 75% to 90% of the cases it is located at the posterior commissure and in the remaining cases it is located at the anterior commissure or, more rarely, in lateral parts. The anal fissure may be acute (occurring suddenly during bowel movement) or chronic (resulting from a superinfection and chronic inflammation).
Main clinical symptoms include: sharp pain in the anal canal during defecation, lasting for up to 30 minutes after bowel movement, bright red blood on stool or on toilet paper, itchiness, discharge from the anus.
Possible conservative treatments include:
- medications to decrease the frequency and intensity of constipations,
- medications to decrease the tension of the internal anal sphincter,
- botulinum toxin,
- calcium channel blockers.
If conservative treatment is not effective, then surgical treatment (lateral sphincterotomy) is necessary. In this procedure the internal anal sphincter is partially divided and the fissure is removed. Specimens are collected and sent for histopathological examination.