Anal fissure is a common anorectal disease, with anal pain as the main manifestation. Severe anal pain can affect the quality of life of patients. In clinical practice, there are some controversies about the treatment of anal fissure, especially the surgical indications. Improper surgical procedures will even cause anal incontinence. However, consensus opinions on anal fissure have not yet been formulated in China. On the basis of summarizing research progress in this field at home and abroad, combined with expert experience, and according to the principle of evidence-based medicine, the Clinical Guidelines Committee has organized experts in this field to form an expert consensus with 13 recommendations on diagnosis, evaluation and treatment of anal fissure for clinicians' reference.
China ; Consensus ; Fissure in Ano/therapy* ; Humans ; Quality of Life

OBJECTIVETo evaluate the clinical efficacy and safety of glyceryl trinitrate (GTN) ointment in the treatment of anal fissure.

METHODSIn this multi-center, randomized, double-blind and placebo-controlled trial, 240 chronic anal fissure patients from 7 clinical centers were randomized to receive eight-week treatment with GTN ointment (treatment group) or vaseline ointment (control group) respectively. Healing rate, visual analogue score (VAS), maximum anal resting pressure (MARP) and adverse reactions were recorded and compared.

RESULTSA total of 221 patients (92.1%) finished the trial, including 114 patients in treatment group (95.0%, 114/120) and 107 in control group (89.2%, 107/120). At the endpoint of treatment (56 d), 90 patients in treatment group (78.9%, 90/114) healed completely compared to 31 patients in control group (29.0%, 31/107), and decrease rates of VAS in the two groups were (94.8±15.7)% and (61.2±35.7)% respectively, both differences were statistically significant (P<0.01). MARP after first administration was (20.2±18.5) mm Hg in treatment group (n=12) and (7.1±14.7) mm Hg in control group (n=6), which was not significantly different (P=0.152). Adverse reaction incidence was higher in treatment group (42.1% vs. 9.3%, P<0.05), while these adverse reactions were mainly headache and fullness in head, which were self-limiting.

CONCLUSIONGTN ointment can effectively promote healing and relieve pain in anal fissure with safety and tolerance.

Adult ; Double-Blind Method ; Female ; Fissure in Ano ; drug therapy ; Humans ; Male ; Middle Aged ; Nitroglycerin ; therapeutic use ; Treatment Outcome

OBJECTIVETo verify the clinical efficacy of acupuncture and moxibustion on defecating and pain symptoms in postoperative patient of anal fissure.

METHODSTwo hundred cases of postoperation of anal fissure were randomly divided into an acupuncture-moxibustion group and a medication group, 100 cases in each one. The basic treatment after the surgery was the same in two groups, besides, acupuncture was applied at Zhongliao (BL 33) and Xialiao (BL 34) in the morning of first 5 days of postoperative 24 h in the acupuncture-moxibustion group, and suspended moxibusiton was applied at Changqiang (GV 1) within 5 to 10 min after defecation; while two bags of forlax was orally administrated in the morning of first 5 days of postoperative 24 h in the medication group. The pain intensity, defecation willingness, defecation difficulty and stool texture during postoperative defecation were observed.

RESULTSThe defecation pain on the first two days after the treatment was not statistically significant between two groups (both P > 0.05). From the third day of treatment, the improvements of defecation pain in acupuncture-moxibustion group were more obvious than those in the medication group (all P < 0.05). The patients in the acupuncture-moxibustion group had more positive defecation willingness than those in the medication group (all P < 0.05). The differences of defecation difficulty and stool properties in two groups had no statistical significance (both P > 0.05).

CONCLUSIONThe intervention treatment of acupuncture and moxibustion has clinical significance on relieving pain symptoms and improving defecation willingness in postoperative patient of anal fissure.

Acupuncture Therapy ; Adult ; Defecation ; Female ; Fissure in Ano ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Moxibustion ; Postoperative Period ; Treatment Outcome

Adult ; Anti-Infective Agents, Local ; therapeutic use ; Female ; Fissure in Ano ; drug therapy ; Humans ; Male ; Middle Aged ; Povidone-Iodine ; therapeutic use ; Pregnancy ; Pregnancy Complications ; Treatment Outcome

Study on the clinical feature and diagnosis was carried out in 51 patients with the anal fistula who received the surgical treatment in the transport hospital I during 7/19997 - 8/1998. The results have shown that the anal fistula occurred mainly in men with ages of 40. The common causative microbes were E.coli, S. aureus and M. tuberculosis. 17.65 of patients had an anal fistula combined with hemorrhoid. The successful rate of the treatment was 95.4%. The relapsed rate was 2.2% and the anorectal incontinence rate was 19.3%.
Fissure in Ano ; therapy ; therapeutics

Study on 21 patients with horse shoe- like anal fistula are treated in Digestive Surgical Department of Viet Duc National Hospital during 1988 -1995 has shown that male:19 (90%); ages:18 -74; relapsed fistula: 81% operated 2 or 3 times: 45% the distance from anal fistula to rear of anal: 4 cm (76%).
Fissure in Ano ; diagnosis ; therapy ; therapeutics

This paper introduced the anatomy of anorectal region, etiology and classification of anal abscess and fistula as well as diagnosis and treatment of anal - fistula.
Fissure in Ano ; diagnosis ; therapy ; therapeutics

Anal fistula treatment still has several difficulties, e.g. high rate of recurrence (20-35%) hypotonic sphincter and incontinence (about 9%). The Millity Medical Institute has treated 300 patients (M: 233, F: 4) mainly high transphincteric one (85.4% by combining modern technique (rubber seton) with traditional (cream made with traditional drugs). Good result: 81%. Not any important complication including hyponic sphincter (incontinence, anal stenosis) are noted. Recurrence: 1%.
Fissure in Ano ; therapy ; therapeutics ; Medicine, Traditional ; Pharmaceutical Preparations