Conservative management There are no clear guidelines on anal fissure management.
Chronic anal fissures are also often accompanied by an external skin tag sentinel pile at the distal end of the fissure and a hypertrophied anal papilla at the proximal end difficult to see on physical examination Fig.
Topical calcium channel blockers are also commonly used to manage anal fissures, although this is an unapproved use.
If you have anal pain for more than 10 days, you should see a doctor to rule out an infection, a complication of inflammatory bowel disease, a hemorrhoidal condition, or anal cancer.
A digital rectal examination is usually not needed to make the diagnosis and is contraindicated in many cases given the associated pain.
GTN ointment is applied to the affected area twice a day and is used to relieve pain caused by the fissure.
An acute anal fissure commonly heals with 4—8 weeks of conservative therapy.
Mayo Clinic in Rochester, Minn.
If the fissure fails to heal within three to six weeks, topical nitrates or topical calcium channel blockers should be used.
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Feingold performs the procedure in the operating room because it has the best lighting and allows patients to have sedation during the procedure.
Once investigated and diagnosed, management of secondary fissures will involve an extensive multidisciplinary approach involving gastroenterologists, infectious disease specialists, oncologists, pathologists and colorectal surgeons.
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Glyceryl trinitrate is commonly abbreviated to GTN.
However, it does carry a small risk of complications.