Internal Anal Sphincter Derangement with Anal Fissures

Resting Anal Pressure Following Hemorrhoidectomy and Lateral Sphincterotomy

“…Many investigators agree that high anal pressure might be a contributing factor to the pathophysiology of chronic anal fissure. [5][6][7][8] The treatment of choice for both pathologies, when conservative treatment fails, is surgery.…”

Clinical, Manometric, and Ultrasonographic Results of Pneumatic Balloon Dilatation vs. Lateral Internal Sphincterotomy for Chronic Anal Fissure: A Prospective, Randomized, Controlled Trial

“…However, internal anal sphincter spasm seems to have a major role in the pathogenesis of this disease, 8 even if it is not always present. 9 Thus, any treatment for anal fissure is designed to reduce, when present, the sphincter spasm, allowing spontaneous healing of the lesion. This healing may be achieved by drugs, surgical sphincterotomy, and anal dilatation.…”

Randomized Clinical Trial of Botulinum Toxin Plus Glyceryl Trinitrate vs . Botulinum Toxin Alone for Medically Resistant Chronic Anal Fissure: Overall Poor Healing Rates

“…Ultraslow waves have been found more frequently in patients with fissures compared with controls, 16 and there is some evidence that these patients have an abnormal rectoanal inhibitory reflex. 17 In patients in whom sphincter spasm is insignificant, it is probably misguided to attempt to lower further the IAS pressure pharmacologically. It is our belief that in patients in this subgroup, fibrosis is an important element in fissure etiology.…”