E-ISSN 0976-2779 | ISSN 0975-8453
 

Review Article 


Modern Therapeutic Approaches to the Treatment of Anal Fissure

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

Abstract
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.

Key words: anal fissure, botulinum toxin, calcium channel blockers, internal sphincter spasm, topical nitrates.


 
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How to Cite this Article
Pubmed Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. Modern Therapeutic Approaches to the Treatment of Anal Fissure. SRP. 2020; 11(5): 377-382. doi:10.31838/srp.2020.5.54


Web Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. Modern Therapeutic Approaches to the Treatment of Anal Fissure. http://www.sysrevpharm.org//?mno=109242 [Access: May 31, 2020]. doi:10.31838/srp.2020.5.54


AMA (American Medical Association) Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. Modern Therapeutic Approaches to the Treatment of Anal Fissure. SRP. 2020; 11(5): 377-382. doi:10.31838/srp.2020.5.54



Vancouver/ICMJE Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. Modern Therapeutic Approaches to the Treatment of Anal Fissure. SRP. (2020), [cited May 31, 2020]; 11(5): 377-382. doi:10.31838/srp.2020.5.54



Harvard Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov (2020) Modern Therapeutic Approaches to the Treatment of Anal Fissure. SRP, 11 (5), 377-382. doi:10.31838/srp.2020.5.54



Turabian Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. 2020. Modern Therapeutic Approaches to the Treatment of Anal Fissure. Systematic Reviews in Pharmacy, 11 (5), 377-382. doi:10.31838/srp.2020.5.54



Chicago Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. "Modern Therapeutic Approaches to the Treatment of Anal Fissure." Systematic Reviews in Pharmacy 11 (2020), 377-382. doi:10.31838/srp.2020.5.54



MLA (The Modern Language Association) Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov. "Modern Therapeutic Approaches to the Treatment of Anal Fissure." Systematic Reviews in Pharmacy 11.5 (2020), 377-382. Print. doi:10.31838/srp.2020.5.54



APA (American Psychological Association) Style

Aleksandra Savosina, Simon Lazar, Svetlana Suslina, Rimma Abramovich, Olga Potanina, Oleg Novikov (2020) Modern Therapeutic Approaches to the Treatment of Anal Fissure. Systematic Reviews in Pharmacy, 11 (5), 377-382. doi:10.31838/srp.2020.5.54