Current status of various treatment modalities in the management of Fissure-in-ano

Fissure-in-ano is a tear in the skin around the distal anal canal below the level of the dentate line, overlying the lower half of the internal sphincter. It is characterized by pain at defecation, burning, itching, and streaks of fresh red blood over a hard stool. It is mainly managed by relaxing the anal sphincter in addition to the use of stool softeners, local anesthetic, and intake of high dietary fibers.Chemical sphincterotomy agents act as pain relievers by relaxing the internal sphincter and are available mainly in ointment forms including nitrates and calcium channel blockers. Besides these, surgical treatment is intended in the patients who fail to respond by other methods. The surgical methods include Internal sphincterotomy, Fissurectomy, Lord's procedure, and other such methods, which are discussed briefly in this article.