Possibilities of medical relaxation of the internal anal sphincter for anal fissures

Abstract

An anal fissure is a longitudinal tear defect in the skin of the anal canal distal to the dentate line. Anal fissure is a socially significant disease that worsens the quality of life of patients. The spasm of the internal sphincter is a guiding pathogenetic mechanism in the development of chronic anal fissures. It leads to circulatory disorder in the anoderm and non-healing wounds. Treatment of chronic anal fissure, as a rule, is based on a decrease in the tone of the internal anal sphincter and in the modern arsenal of coloproctologists there are both surgical and pharmacological ways to eliminate spasm. Lateral internal sphincterotomy is still the gold standard for the definitive treatment of anal fissure, but anal incontinence is a serious complication of the procedure. This article presents an overview of the available modern means for drug relaxation of the internal anal sphincter and the authors' experience in using the first fixed-dose combination of 0.3% nifedipine and 2.0% lidocaine topical gel authorized for use in Russia in patients with the chief complaint of pain during and after a bowel movement that requires the use of analgesics. A spontaneous wave activity in the resting phase, which indicated the presence of anal sphincter spasm, was recorded in all patients. According to our observation, the complete healing of the anal fissure and the anal sphincter relaxation was instrumentally confirmed in 70% of patients.

Keywords

• anal fissure
• internal sphincter spasms sphincterotomy
• botulinum toxin
• nitroglycerin
• diltiazem
• nifidipine
• relifipine