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The inciting trauma to the anus produces severe anal pain, resulting in anal sphincter spasm and a subsequent increase in anal sphincter muscle pressure. Botulinum toxin is injected directly into the internal anal sphincter muscle to promote anal sphincter relaxation and subsequent healing. Patients note severe pain during, and especially after a bowel movement, lasting from several minutes to a few hours. Both of these are performed typically as outpatient procedures. These diseases cause atypical fissures that are located off the midline, are multiple, painless, or non-healing after proper treatment. The increase in anal sphincter muscle pressure results in a decrease in blood flow to the site of the injury, thus impairing healing of the wound. Your colon and rectal surgeon may request additional tests, even if your fissure has successfully healed. Acute fissures may have the appearance of a simple tear in the anus, whereas chronic fissures may have swelling and scar tissue present. Quite commonly, anal fissures are misdiagnosed as hemorrhoids by the patient or the primary care physician due to some similar symptoms between the two. Anal fissures can occur at any age and have equal gender distribution. Topical anesthetics, such as lidocaine, can be used for anal pain and warm tub baths sitz baths for minutes several times a day especially after bowel movements are soothing and promote relaxation of the anal muscles, helping the healing process. Anal fissures may be acute recent onset or chronic typically lasting more than weeks. If any incontinence is present after surgery, it may resolve over a short time period. Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids.

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Description: Treatment strategies are aimed at interrupting this cycle to promote healing of the fissure. These medications include diltiazam and nifedipine. Acute fissures may have the appearance of a simple tear in the anus, whereas chronic fissures may have swelling and scar tissue present. Your colon and rectal surgeon will go over each of the potential risks and benefits of sphincterotomy and will decide if this procedure is right for you. Nitroglycerin can be used for variable lengths of time and can be utilized again if sustained healing is not achieved. A fissure that fails to respond to conservative measures should be re-examined. The main risks of internal sphincterotomy are variable degrees of stool or gas incontinence. The inciting trauma to the anus produces severe anal pain, resulting in anal sphincter spasm and a subsequent increase in anal sphincter muscle pressure. Patients suffering from persistent anal pain should be examined to exclude these diseases. If the problem returns without an obvious cause, further assessment may be warranted. Nitroglycerin works by chemically relaxing the internal anal sphincter muscle, which decreases sphincter pressure and subsequently increases blood flow to the injury site, resulting in healing of the fissure. Patients must also be cautioned that a drop in their blood pressure may occur, especially if other anti-hypertensive medications are being taken. Fissures can recur easily, and it is quite common for a fully healed fissure to recur after a hard bowel movement or other trauma. If a sentinel pile is present, it may be removed to promote healing of the fissure. Patients in whom Botulinum toxin injection fails are oftern recommended for traditional surgical sphincterotomy.
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