Management of anal fissures: Latest guideline by American Society of Colon and Rectal Surgeons
USA: The American Society of Colon and Rectal Surgeons has issued updated clinical practice guidelines for managing anal fissures, published in Diseases of the Colon & Rectum.
An anal fissure is a linear tear within the anal canal that extends from the dentate line toward the anal verge. The most common location of anal fissures is in the posterior midline (73%). Still, they can be found in the anterior midline in 8% of men and 13% of women, with 2.6% occurring both anteriorly and posteriorly simultaneously.
The updated recommendation for the management of anal fissures is given below:
· Nonoperative treatment of acute anal fissures is safe, and authors recommend that it should typically be a first-line treatment.
· The authors recommend that anal fissures be treated with topical nitrates, although headache symptoms may limit their efficacy.
· The authors recommend using calcium channel blockers for chronic anal fissures as they have similar efficacy and a superior side-effect profile compared with topical nitrates and can be used as first-line treatment.
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