Local thermal stimulation relaxes hypertonic anal sphincter

Jiang, Jeng-Kae; Chiu, Jen‐Hwey

doi:10.1007/bf02238567

Cited by 31 publications

(16 citation statements)

References 15 publications

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“…[30], [31], [32], [33] A 2%GTN ointment applied twice to the anoderm for 6 weeks results in a complete healing in 98% of patients. [6] In another study, Topical diltiazem ointment was used as an agent for chemical sphincterotomy for chronic anal fissure. The Study claims to offer significant healing rate and reduced incidences of side effects.…”

Section: Topical Nitratesmentioning

confidence: 99%

“…[5] Warm sitz baths may lead to healing of anal fissures via a somatoanal reflex that results in relaxation of the internal anal sphincter. [6] In a randomized study conducted by Jensen, treatment with 10g of unprocessed bran twice daily and warm sitz baths for 15 minutes twice daily and after each bowel movement resulted in quicker symptomatic relief and better healing at 3 weeks (88%) compared with 2% lignocaine ointment or 2% hydrocortisone cream. [7] According to the practice parameters set by the American Society of Colon and Rectal Surgeons, increased fluid and fiber ingestion, the use of sitz baths, and if necessary, the use of stool softeners are safe, have few side effects, and should be the initial therapy for all patients with anal fissure.…”

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confidence: 99%

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Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

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Anal fissure is one of the most common anorectal problems. Anal fissure is largely associated with high anal sphincter pressures and most treatment options are based on reducing anal pressures. There are many options to treat chronic fissures in ano. Some of them are non-surgical while the others are surgical. The efficacy claimed by each of the prevalent method is very high but the inconsistencies and contraindications are equally strong. To date, lateral sphincterotomy has been favoured by most of the proctologists, because it is the least extensive surgical procedure and is offering a long lasting relief in sphincter spasm. Various management technique are reviewed in this article along with Advancement flap for anterior fissure and a new method combining the age-old technique of Lord's manual dilatation followed by radio surgery is also highlighted along with their complications. The addition of radio surgery is found useful for refreshing the edges of the fissure and to tackle pathologies namely sentinel pile, small internal piles or hypertrophied anal papillae often found associated with chronic fissures. Revisiting the trends of treatment of chronic anal fissures, the most preferred options are the manual dilatation with radio surgery and the subcutaneous lateral anal sphincterotomy. Both methods are easy to perform, have negligible complications and no special setup is needed, except the radio surgical unit, in case of the first procedure.

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Section: Topical Nitratesmentioning

confidence: 99%

mentioning

confidence: 99%

Anal Fissure Revisited : A Systematic Review

Singh¹,

Chandrakar²,

Agrawal³

et al. 2015

jemds

View full text Add to dashboard Cite

show abstract

“…Initial conservative measures have consisted of three components: relaxation of the internal sphincter; institution and maintenance of atraumatic passage of stool; and pain relief. These goals can be accomplished with bulk agents and stool softeners, and war m sitz baths following bowel movements to relax the sphincter [32,33] . Warm sitz baths (not to exceed 120°F) may ease the acute pain in the anal area.…”

Section: Treatmentmentioning

confidence: 99%

What every gastroenterologist needs to know about common anorectal disorders

Schubert¹,

Sridhar²,

Schade³

et al. 2009

WJG

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Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. However, gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or nonsurgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani.

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“…It is important to emphasize that, in the case of acute anal fissures, conservative treatment can provide a cure in 87% of the cases, while in chronic forms this figure is 50% [28–30]. …”

Section: Introductionmentioning

confidence: 99%

The management of patients with primary chronic anal fissure: a position paper

et al. 2011

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Anal fissure is one of the most common and painful proctologic diseases. Its treatment has long been discussed and several different therapeutic options have been proposed. In the last decades, the understanding of its pathophysiology has led to a progressive reduction of invasive and potentially invalidating treatments in favor of conservative treatment based on anal sphincter muscle relaxation. Despite some systematic reviews and an American position statement, there is ongoing debate about the best treatment for anal fissure. This review is aimed at identifying the best treatment option drawing on evidence-based medicine and on the expert advice of 6 colorectal surgeons with extensive experience in this field in order to produce an Italian position statement for anal fissures. While there is little chance of a cure with conservative behavioral therapy, medical treatment with calcium channel blockers, diltiazem and nifepidine or glyceryl trinitrate, had a considerable success rate ranging from 50 to 90%. Use of 0.4% glyceryl trinitrate in standardized fashion seems to have the best results despite a higher percentage of headache, while the use of botulinum toxin had inconsistent results. Nonresponding patients should undergo lateral internal sphincterotomy. The risk of incontinence after this procedure seems to have been overemphasized in the past. Only a carefully selected group of patients, without anal hypertonia, could benefit from anoplasty.

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Local thermal stimulation relaxes hypertonic anal sphincter

Abstract: Local thermal stimulation evokes relaxation of the hypertonic internal anal sphincter through a somatoanal reflex, thus providing an easy and feasible method of clinical application.

Cited by 31 publications

References 15 publications

Anal Fissure Revisited : A Systematic Review

Anal Fissure Revisited : A Systematic Review

What every gastroenterologist needs to know about common anorectal disorders

The management of patients with primary chronic anal fissure: a position paper

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